Protrusive Dental Podcast

2021 UPDATE: If you want to learn more about Splints, check out the SPLINTEMBER Series I recently did: Which is the Best Dental Splint? Stay Away from TMD Michigan Splints are Overrated Anterior Only Occlusal Appliances Part 1 Anterior Only Occlusal Appliances Part 2 Pre-register for the Online Splint Course which will get rid of Splint confusion and teach you theory and practical you need to know to be confident with Splints (all types!) The use of anterior mid-point stop appliances (AMPSAs) in Dentistry is surrounded with controversies and misconceptions, so I am joined by Dr Barry Glassman in this episode to answer this much debated question. Need to Read it? Check out the Full Episode Transcript below! Attending Dr Glassman’s lecture last year was eye opening and career-transforming for me. It changed the way I thought about Occlusion! In this Episode with Dr Barry Glassman we discuss: To what extent are occlusions designed for Function? How much does Occlusion matter? Why canine guidance? Do Anterior midpoint stop appliances cause posterior teeth to over-erupt? When to avoid using AMPSAs? What mechanism is behind patients developing AOB after splint therapy? This is an example of a lower NTI or SCI (Sleep Clench Inhibitor). This falls in to the category of an anterior mid-point stop appliance (AMPSA) TLDL (Too Long Didn’t Listen): Jump to 22 mins and 30 seconds if you want the main question answered. Protrusive Dental Pearl: The BRB technique for incisor Class IV build ups to create an ‘instant wax-up’ within the putty. You can read more about this technique at Style Italiano. Do not miss out on the next Dentinal Tubules Congress in October! Dr Glassman will be lecturing again in the UK on ‘Myth-busting Occlusion for the General Dentist‘. He will be lecturing in Sheffield and London and this can be booked on the S4S website. If you use the discount code BG-PODCAST, this will give 30% off (RRP £179.99). If you want a substantial online training for Splints, the Online Splint Course is just weeks away from launch!  Barry Glassman, DMD, maintained a private practice in Allentown, PA, which was limited to chronic pain management, head and facial pain, temporomandibular joint dysfunction and dental sleep medicine.   He is a Diplomate of the Board of the American Academy of Craniofacial Pain, a Fellow of the International College of Craniomandibular Orthopedics and a Diplomate of the American Academy of Pain Management.  He is a member of the American Academy of Orofacial Pain and the American Headache Society.  He is on staff at the Lehigh Valley Hospital where he serves as a resident instructor of Craniomandibular Dysfunctions and Sleep Disorders.  He is a Diplomate of the Board of the Academy of Dental Sleep Medicine.  He has published articles that have appeared in both peer and non-peer reviewed journals in the fields of dental sleep medicine and orofacial pain.  Click below for full episode transcript: Opening Snippet: Most of us, unfortunately go to lectures to have what we already know. Justified. So as long as long as someone is telling me what I know and is what I'm doing is right has been right, then I can take on a new parole or something and add to it. I'm comfortable with that. If someone's telling me that what I've been doing may not be right, that's upsetting. And what I've been saying, Jaz, for years is that I'm not saying that what you've been doing is right... Jaz’s Introduction: Do anterior midpoints stop appliances cause anterior open bites? Right, so if you’re unfamiliar with these appliances, it’s basically a night guard that only covers that say, 2-2 or 3-3 or 5-5. And there’s many combinations and you know, opposing and whatnot, a larger, smaller, but essentially they don’t cover all the teeth. They are segmental appliances. And the classic version of it, for example would be like an NTI or in the UK is known as a SCi, sleep clench inhibitor. Other versions are available bite soft, FOS which is something I use quite a bit or B splints, there’s loads of different types. So if you’re listening to this podcasts, and you’ve sort of clicked on to find out if these sorts of appliances, cause anterior open bite probably you’ve come across or seen photos, or perhaps you use these cautiously, or perhaps you use this freely, let’s find out. Basically, if the back teeth don’t touch the muscles switch off. That’s essentially how it works. So you’re biting together on the night guard, you’re biting only at the front, the back teeth don’t touch the muscles cannot contract efficiently with the power that they can do when back teeth contact. Why did I do this episode? It’s a huge discussion point full of controversy. Basically people are convinced that these sorts of appliances, imagine one example covering 2-2 will cause an anterior open bite by the posterior teeth over erupting. So I invited an expert in this field in oral facial pain, Dr. Barry Glassman to speak on this topic to give clarity on where these appliance do actually cause such issues. Today’s Protrusive Dental pearl, BRB technique, okay, this is for class four composites or any sort of build up in composite. It’s not the ‘Be Right Back technique because a brb might be, it’s actually called, but Bertholdo/Ricci/ Barrotte (BRB) technique, and it’s shortened to BRB, if you have someone who has had a class four fracture, let’s say and you need to do a nice build up and you want to do a layered approach. Usually, classically, you’d have to do some sort of a wax up and then may take a putty stent on both wax up and then transfer it on, therefore you’ve got your palatal thickness, and therefore you can build the anatomy into the putty index now. So with the brb technique, you’re basically negating the need for wax up, you take a puttyy index to include the fracture tooth, you’re just taking the putty index of the situation you have in front of you, including the adjacent teeth so that you know later you get a positive seat of the stent. And then what you do is with a pencil you draw on the putty where you would like the incisal edge to be, you basically use the adjacent teeth as a guide. And then using a round ended tungsten carbide bur, you remove the silicon putty where you’ve demarcated with a pencil. So essentially, you’re creating the wax up with the bur into the putty. And there we are, you have your instant wax up within the putty to actually build the class four fracture to the correct shape and morphology using a layered approach. So it’s a neat little trick, and I’m going to share that on the blog www.jaz.dental. And you’ll be under this episode in the show notes which you can download as a PDF. So let’s listen to the interview with Dr. Barry Glassman. And for the record of the time of production, I have no financial interest with s4s or Dr. Glassman seminars, some of the terminology and ideas that Dr. Glassman shares can be quite difficult to grasp over audio at the first listen anyway. And quite high, I thought was quite high level expert knowledge he shares with us and some of it went beyond me as well. But I’m hoping that this will settle the debate about anterior midpoints stop appliances and whether they cause anterior open bite. Main Interview: [Jaz] Thanks so much for agreeing for this honesty it was like I don’t know if you’re into sports and football but it felt like in the last minute of the transfer window in football when you manage to to sign a new player and everyone’s really excited. So that’s how it felt like to me. [Dr. Glassman]Well, that’s crazy, but that’s great. No, problem. [Jaz]I don’t want to say off the bat. Your lecture that I went to last year at the BDA in London was actually life changing for me in the sense that you know I’m really into occlusion Okay? So that’s why the whole year this podcast called the Protrusive Dental podcast is not just about occlusion, it’s about all sorts of things in dentistry, but it sort of has a flavor I’m into it. But then your perspective on it, I thought was so, so powerful. And I’m so glad that, you know, hopefully, we can share that with our listeners today. [Dr. Glassman]Surely. So let’s start with that. How did it change your perspective? [Jaz]Really, you rewired my brain. And I know you know exactly what I mean, because we just don’t get taught to think about it the way you explained it. So basically, the what I took out from it was when we design you know “occlusal harmony”, when we have everything in canine guidance, when we have everything and in class one, that only, it only really happens when the teeth are together. And that’s obviously the gist of what you’re saying. But when we design occlusions, we design them. And please tell me if I misinterpreted what you said, We design these occlusions for parafunction, we don’t design them for function, but we design them with parafunction in mind. And actually, the only time it matters is when the teeth are together. And maybe the crux of the problem is parafunction is the fact that the teeth are together for too long. What do you think about that? [Dr. Glassman]I feel like there’s absolutely that is if I were hoping that someone would walk out of the lecture with something that there are two things you’ve said that make me feel as though you that I was successful in that lecture. The two things were Yes, that we design occlusions for parafunction not for function, that when we look at the amount of time that teeth are actually together, and whether they’re actually together when we function, and when we think about it, we don’t really, we don’t ask patients at the end of restorative visit that the next time were they able to eat meat the next visit. Very rarely a complaint that patients have, I can’t eat as well as I did. The show that so it’s really, when we look and see where are those teeth contact during function. What we know is that it’s unpredictable it has nothing to do with what we could evaluate on an articulator. And as you know, you can’t look at a case and say, Well, this is where it’s going to hit when we’re functioning, we have no idea, if it’s going to hit our or where it will hit or what inclines and etc. And it has a lot to do with our, you know, the masticatory cycle and the bolus and the kinds of things that you know, this amazing body that God or Darwin has put together has created and it’s overwhelming the amount of proprioceptive and mechanical receptors, information that goes into the buttons of our nucleus and into our central nervous system. [Jaz]I recently learned to appreciate that what you’re saying there is I read a book a handbook by someone called Jay Levy, I think I believe is based in the states and his sort of research was, just how much sensory feedback is contained in teeth, sensational amounts [Dr. Glassman]I mean, the spirit of the whole mandibular function it just it we can’t even pretend that we can no and this doesn’t make us any different than medicine. It’s not like medicine knows. When we look at a car accident we look at where someone gets injured and we’ll try to we try to figure out the force vectors.We can we know that you know, there’s there’s no relationship between the amount of force and the amount and of cracks and the amount of damage done to an individual. It all has to do with magnitude and direction of force vectors that are too difficult for us to analyze. [Jaz]Absolutely. But before we delve in any any more Dr. Glassman, I just want to say for because some people may be listening and they don’t know who you are. And I feel like we got so into it because I was I was sharing my excitement of having you on. So again, thank you so much for joining us. I noticed that your you know your diplomat of so many things diplomat of the board of the American Academy of Craniofacial pain, the Headache Society, Orofacial pain, I’m just picking a few of what you are. Tell me [Dr. Glassman]Jaz, I don’t really know that all that you know, to be honest with you, I appreciate that. I don’t know that there isn’t any of those that make me feel you know that make me qualified enough to speak on the subject as much as my intense interest in science that I find this fascinating is rivaled by so many others like yourself. So it’s Yeah, I appreciate all that. And I know that that looks. You know, people look at those things. But you and I both know that that’s there are lots of that. If I look at some of the restorative gurus and I look at some of the things that they you know what they’ve accomplished. You would think that there end therefore will carry weight. And I listened to what they say. And I shudder. [Jaz]Well, listen, you’re very humble. For anyone who wants to read it. There’s a list of, you know, your credentials if you like. But, look, I can say that when I went out lecture last year, it really resonated with me. And then I read a chapter of yours in a book by Steve Hudson, that you did. I’m trying to remember that is, I think, is it messages from dental masters? I think it was that one. Anyway. And it was you were discussing about the whole teeth occluding together and whatnot in which we’re going to come on to this in the podcast, but definitely, you’ve had a massive impact on my career, my treatment planning, my thought process. So thank you so much for that. And I want to be able to share that with everyone. So yes. How did you get into being interested in this field in particular, ie, I guess the wide term would be a occlusion, but you might want to call it something else orofacial? What do you want to, How do you want to describe that? [Dr. Glassman]Pain management, joint dysfunction? [Jaz]So how did you get into that? [Dr. Glassman]Yeah, it’s the way that I think many of us get into it, I took what one of the reasons I teach Jaz is that I tried to avoid for everyone else in our profession, the treacherous path that I wound up taking, I got into in the late 70s, before many of you were born, I was cheating a young woman in her mid 30s, that I truly believed and trusted, who had specific maxillary bicuspid pain. And no matter what anyone ended on this, they eventually had the tooth extracted, eventually had the bridge placed and nothing could resolve her pain and someone came. And at that point, a flyer came across my desk to be to go take a course with Niles Guichet, who was teaching the what was called this occlusa studies, society for occlusal studies. And his basic concept was that everybody should have their condyle up and back in a reproducible position. [Jaz]Where I ever heard that one before? [Dr. Glassman]Yeah, exactly. [Jaz]Then happen? [Dr. Glassman]And well, I don’t want to go through the whole I, the reality, is that I went from camp to camp I studied with Harold Gal for seven years, I studied with neuromuscular with bio research for years. And I was just, you know, looking for more answers. That, and believing everything I was told, when, in fact, all this much of that information. And as much as I have respect for many of these, what I call pioneers, people who, created a path for the science that we now have, just like those pioneers were fabulous, we certainly wouldn’t want to be using the maps created by the original pioneers in the United States. And unfortunately, those pioneers were very happy to see growth and change in their map. Unfortunately, our gurus don’t want to see growth and change because it seems, to they seem to be very protective of their legacies. And so when science comes around and demonstrates that maybe some of the things that they were teaching wasn’t accurate. For example, interference is causing hyperactivity and lateral pterygoid spasms, which we now know doesn’t happen, [Jaz]All the myths that are out there, as someone who you know, I, religiously, but I go to a lot of occlusion courses, it’s my thing I really enjoy, I really do enjoy, you know, the whole temporomandibular disorders, doing more complex rehabilitation and stuff. So I you when you’re designing an occlusion from scratch, when you’re trying to protect your restorative work, I suppose, then you do, I do follow those principles of you know anterior guidance and that sort of stuff, the sort of thing, which only really matters when your teeth are together. But I think when you’re doing a rehabilitation, you sort of have to begin from somewhere. [Dr. Glassman]If you have a choice between having more forces during parafunction, or less choices, why would you take more? So the answer is, of course, that’s exactly right. There’s nothing [Jaz]and I feel some people are misunderstood you Dr Glassman I don’t know if you know, but I feel as though some people think that what you have to teach is saying that you can do anything you want and you don’t have to follow strict protocols, or do you know the way that we’re supposed to a full mouth rehab? I think they’ve misunderstood what you’re trying to do and what your messages and that’s what I’m hoping to send out today. [Dr. Glassman]Well, I get that in all the words I get a lot of interpretation. I will I’ll say occlusion doesn’t matter unless you’re occluding, and people only hear the first part. And so they only hear that occlusion doesn’t matter. And the problem, Jaz, with that is is that it and the reason they hear that is because everyone’s telling them how important that occlusion is the key. It’s the answer. And if and so as soon as I say occlusion doesn’t matter. It just turns people off. I’ve learned it You know, it’s funny, I will not accept an invitation to speak at a study group for an hour on occlusion. Because I know at the end of the hour, I don’t have enough time to do what you said in the very beginning, the first thing you said to me was you were rewired to think differently. Well think about that, Jaz. In order to be rewired, you have to get rid of the existing wiring. And then you have to rewire. [Jaz]Yes, you have to open yourself up. And I’m sure people come to lectures and didn’t have an open enough mind. And they were just very set in their ways. I’m sure we have stories, people, maybe I don’t know, Has anyone ever walked out? [Dr. Glassman]Oh thrown stuff at me, you know, and I and no question I get, there are people that had to do when, many of us go to lectures, for many reasons, no one in in the UK, I’m gonna say going to the UK, it’s not as much fun because everyone’s so polite, but I have always very respectful. And I have no idea how angry some people are. Because I, you know, because of the tendency to be respectful. In the United States, they’re not quite as respectable, so that we’ll go ahead. And I mean, you know, we’ve got Trump as president for God’s sake. So, they’ll go ahead and throw it off and interesting to me, you know, whatever. But so what I’m saying is that people go to lectures for various reasons. And the most of us, unfortunately, go to lectures to have what we already know, justified. So as long as someone is telling me, what I know, and is what I’m doing is right has been right, then I can take on a new pearl or something and add to it, I’m comfortable with that. If someone’s telling me that what I’ve been doing may not be right, that’s upsetting. And what I’ve been saying, Jaz, for years is that I’m not saying that what you’ve been doing is a right. If you’ve been receiving success, and doing whatever you’re doing no one who would, whom I say it isn’t right. What I am suggesting, is that maybe it was right for other reasons that you suspected, maybe it’s right, because the mechanisms that are at play, the contributing factors that we’re touching, are different than you suspect that they are. And if we are truly understood better, both the contributing factors that we were controlling, as well as the differences that exist from patient to patient, then we could put our treatment into better perspective and help more people more conservatively. [Jaz]Brilliant. Well, I think people are listening to this now and I feel some people may be saying well hang on what is the crux of where are we going to. So the main reason I want to get you on is because I you know you’re someone who based on that lecture I went to, I can speak to you for days and days and days you know I’m really really love the devotion you put into this to come up with something so simple. But obviously your lecture, you’re coming to London and Sheffield soon you’re lecturing about it. And I can give people the details, but I wanted to just homed in on one specific thing and that was anterior midpoint stop appliances. I see on you know, I’m sure you get your I know you get tagged on Facebook and stuff all the time and people getting into that debate and use it I’m sure you’re sick of it, seeing it all the time. Okay? Basically, when I was at dental school, though, that these appliances are the devil’s work, because they will cause over eruption of the posterior teeth. And you will get an anterior open bite and all sorts of terrible things will happen to you. So can you please tell me or tell the audience I know already from going in lecture, but why this may not be the case or it may be the case but and perhaps in a different mechanism? [Dr. Glassman]Okay, so let’s talk about first of all, why we use anterior midpoint stop appliances? So the or what the purpose of any appliances? So I would ask you as a dentist, you’ve got a patient and you’ve got let’s say something very specific. We’ve got a patient with some joint pain upon wakening and a suspicion of an early internal derangement of some sort, whether it be an inflammatory state, whether it be this slightly compromised, tethering of the disk and some clicking. So we’ve got some low level clicking and significant joint pain upon awakening. Okay? So that’s what we’ve got a patient that that dentistry will say has some TMJ or TMD, which, as you know, drives me crazy. But nevertheless, but we can’t get into everything. So I say to a dentist, general dentists, what are you going to do? He says, or you know, I’ve got a patient that and you know that they brux their teeth, you can look you can see wear patterns etc. So what are you going to make? He says, Well, I’m gonna make a night guard, great. I said, so and you tell me as a dentist, as someone before you took my course and someone said, I want to make a night guard. And I would say to you, what’s the mechanism? How is that night guard going to help? [Jaz]So before I’ve done your course, I would have said, I’ll make a bite raising appliance or wherever it is. So maybe a soft bite night or maybe a Michigan splint, if I was feeling fancy if the patient afford it, and the mechanism that would work would be raise the bite, therefore, it will take the condyle slightly away from the fossa and allow, you know, the inflammatory exudates, to be cleared and reset the system. So they will stop bruxing. That’s what I probably would have said beforehand to which I, you know, [Dr. Glassman]Well, no, that’s a great answer. That’s a great answer. Because that’s, you know, and everything in that answer is wrong. So there is some, in fact, to be honest with you guys, that’s a better answer, then I usually get when I asked Dennis. So obviously, your interest is greater than many and many who may be listening may not have come up with all that, or maybe some of you would have that’s great. The reality is that yes, we know that there is no true what we were taught in dental school, remember that we’re taught about the first 20 millimeters is pure rotation. And we know that isn’t true. So we know that there’s a meeting. [Jaz]That’s correct. Well, that’s why I understand not only from your course, and I went on I read further and I delve further into it. So yes, I now accept that it’s not purely rotation. Yes, it isn’t an articulator but not in the mouth. Right? [Dr. Glassman]Right. In articulate has nothing to do with actual the way condyle actually function. Yes, so now we, so as soon as we put something between the teeth, now when the elevators contract and bring our teeth up against it, we can’t close as far as we could have. And consequently, our condyle when we’re done, we’ll be further anterior than it would have been if we had not that piece of plastic in our in between our teeth. So yes, we bring that condyle, down and forward. And if there’s an inflammatory state, and there’s there’s a potential, reducing it, what we haven’t done is we haven’t significantly altered. So the force magnitude, the magnitude, what we know is, and we show this in the courses, remember, we actually have a video where we show you that when there is dental contact, we all know this as dentist, we all know that what’s the purpose of lateral excursions, canine rise and lateral excursions it is in both countries would say it shuts off musculature. What does that even? [Jaz]That’s right, Bob? And I would like to say please correct me because I, you know, please correct me if I’m wrong, but what I’ve been understanding is that on your canines, it goes down to 30% of maximum? [Dr. Glassman]I don’t know that. That may be it, what we do know is we look at the studies of Victoria and others, the further posterior the contact, the greater the forces in terms of magnitude. So your canine contact is better than bicuspid contact. But I’d rather not have canine contact, canines, what we’ve learned our posterior teeth-functionally, but anterior teeth-aesthetically. So giving a patient canine rise in their natural dentition, as you earlier explained, is the best parafunctional control that we can obtain in a natural dentition. And oftentimes, Jaz, that’s more than adequate to keep our patients within their adaptive capacity, I’d actually have our patients heal if they didn’t have that level of protection prior to us giving it to them. So, whether we give it to him with an appliance on Michigan, whether we give it to him within our calibration, we have the potential to help patients in that regard, no question about it. So when people say, I say that you can’t help people with you know that you need to have anterior midpoint stop appliance, they never said that. That’s not what I’m saying. What I am saying is that in even superior way to reduce those forces, if we look at the study of May in 2000, where they looked at EMGs, and they looked at specifically at condylar compression, we find that in anterior midpoint stop despite what we’re taught that it’s going to increase the force because of the lack of posterior support, we find out that that’s not true, that it actually decreases the compression and that when you combine the magnitude and direction of the, because of the direction of the masseters, anteriorly and the anterior temporalis was as in the anterior component, there’s nothing driving that condyle back the way we were taught into retrodiscal tissues. [Jaz]It’s like a nutcracker, but your furthest away from the hinge part of the Nutcracker. Right? [Dr. Glassman]So you’re describing, interestingly enough, what you just described is the alteration in the force, in the magnitude of the force. So yeah, so as the more anterior we come the further we get away from a class one lever, the forces decrease. But more importantly, also were as importantly, is that not only those forces decreased, but they don’t incorporate what we’re taught that those forces will incorporate with an anterior midpoints. They don’t incorporate a posterization of the condyle, leading to pressure against the retrodiscal tissue, and pain. If so that the purpose then of the anterior midpoint stop is to create the best environment, or altering the force direction and decreasing the force magnitude during a parafunctional event that has no known cause [Jaz]Perfect. So then why don’t they cause an anterior open bite, that’s the next thing you’ll find that, you know, written around people. The main reason why people don’t use it. I was scared for the first three years when I was qualified of using these appliances, even though I taught, been reading about it, but I was scared to use it because I think I’m gonna get sued, it’s gonna happen. This is not the right way. So I was scared because of that, the myth that it’s gonna cause an anterior open bite because your posteriors will start over erupting. So, can you please bust this myth? [Dr. Glassman]Yes, they don’t overerupt. [Jaz]there we are, it’s finished. [Dr. Glassman]So, what, it is facile. So your concern is appropriate, and you should be concerned. So, let’s make a couple of statements. Number one, posterior teeth don’t over erupt. Over erupt cause there’s an anterior midpoint stop appliance in place any more than they will over up without an anterior midpoint stop in place. So when Avaya said you jazz, are you wearing an appliance at night? Say No. No. Good. Good answer. What made you say that? Okay, so are you wearing appliance tonight? No. So then if you’re not wearing an appliance at night, what keeps your teeth from over erupting? And someone would say well, the dental contact that’s what are you talking about? There is no dental contact is as you go deeper into sleep, there’s more and more muscular relaxation, your use you swallow tooth 3000 times a day, but you only swallow two to nine times an hour, you swallow with less veracity, the EMG levels are less and the likelihood of reaching MIP during those walls is next to zero [Jaz]In a non parafunctional person, right? [Dr. Glassman]Next to zero in the swallow. Okay. That Yes, in the swallow. So, what is it that keeping your teeth from erupting? What is that? How is it very different than if I put an anterior midpoint stop appliance in? So why? Why aren’t we getting supraeruption normally, so the reality is this, but you and I have dentist and we have seen when we lose an opposing tooth, we get super eruption. And and when we look at the studies of Robert and the studies of others, what we see is that after 16 hours, there are true bicular changes that lead to the super eruptive activity. So consequently, as long as these teeth are in function, the likelihood of supraeruption becomes next to zero. So I have patients for example, Jaz that wear their nighttime appliances. They were a daytime appliance, which we call a maxillary anterior passive appliance that they wear at during the day to stop their bruxism, especially dentists, just sayin. So they wear their daytime appliance, they wear their nighttime appliance. And as long as they remove these appliances to eat, the likelihood of developing an anterior bite goes extremely low. Now, when interestingly enough, when these anterior open bites do occur, and they do when they do occur, if you then and we’ve done this over and over, I worked with Keller labs who makes the their work in the United States or NTI is in the UK there are SCis. And I’ve worked with Keller lab that made these NTIs and we did a whole bunch of studies with patients who developed it to your overbites and I did them with my own patients. And what we found is that if we took them two models of those patients and put those models, they fit together perfectly. Clearly this was not then supraeruption, there was something different happening. Now I explained this in the course and I don’t mean I don’t want to make light of this or skip over it because It’s awfully complicated, but what [Jaz]It is. And I think that the course gave it the Justice and the time it deserves, because this gets discussed about so much. And it’s such a big issue in appliance selection that people are worried about. So it does deserve more time. But I think people appreciate that, you know, we’re trying to keep it concise. Yeah, yeah, [Dr. Glassman]We talked about what we’re looking at is literally a change in Chi forces, and the change in the trajectory pattern in the neck. So the bottom line is this is that you never want the punishment to be worse than the crime. So we would never suggest that you use an anterior midpoint stop appliance in an asymptomatic patient with specially if the overbite is a as less than a millimeter, because that’s the patient that could open up on you and and you go, Oh, my God, what happened? And now the patient can bite off letters or something, and which is no big deal. My pain patients, they could care less. But if they didn’t have pain in the beginning, then the punishments worse than the crime and they’re not happy and they shouldn’t be at. [Jaz]That’s a fantastic way to say it. You know, I still remember that saying that. And I say to my patients, you know, what you said, and you know what the other thing I say to my patients what you told me? Okay, and you said these three words already to me? [Dr. Glassman]I don’t know. [Jaz]Okay, yes, it is exactly. You said, I don’t know. Cuz I said 30% of the canine thing. And you’re like, I don’t know. And, you know, I think we had a moment at that lecture, where you just, for the first time said, Look, it’s okay not to know, don’t just say, I don’t know, just learn to say it and [Dr. Glassman]We actually have everyone say it together. Because here’s the reality, I got sick and tired of going to all these gurus that knew everything. And when they didn’t know, Jaz, they made stuff up. They just made it up to connect the dots. Because God forbid, you know, you paid the money, they should know the answers. And the answer is often is I don’t know. So I got over the, you know, a lot of people got really upset with me, because it’s a guy, you know, I paid a lot of money to hear what you don’t know. So I changed it to. It’s not No. [Jaz]It’s not No, but you know what, it’s still though that was a great thing. So thank you for changing that about my life as well. So right, so we said, What anterior midpoint stop appliance are, we talked about scenario patient. We talked about how through mechanisms, they cannot cause an overeruption, but they can cause AOBs due to condylar repositioning? Is that the best term? [Dr. Glassman]I know, I would say they it’s possible for the use of an anterior midpoint stop to contribute to an anterior open bite with altered trajectory as a result of usually an improvement in the cervical kyphosis or cervical lordosis. So that’s a little it’s really not condylar position, as much as it is the altered trajectory. [Jaz]Can you make that a bit more tangible? Because some of those terms i’m not i’m still unfamiliar with. Can you make it idiot proof for someone like me? [Dr. Glassman]Sure. Take your lower jaw and rest it. Close together. All right. Now, if you just take your lower jaw and rest it now, and move your jaw slightly forward, or just forward just or from that position, don’t moving forward, just change the way you close to alter the trajectory. So now you’re only hitting your anterior teeth. Alright, you starting in the same position, your condyle is in the same position, what your trajectory changed. Now just imagine you can’t do this, just imagine you change your trajectory. So that your, whole mandible closes with a with a back teeth touching are going to hit first. Now because with that change in trajectory, you’ve got an anterior open bite, your teeth are exactly the same. You haven’t changed but the trajectory changes, the musculature and combined with the posture and your and your and your head, neck. Now if you change you know, it’s it. Think about this, you How many times have I seen a dentist spend an hour two hours perfecting an occlusion, just making everything perfect and the patient’s lying down in the supine position and they’re gone tap, tap, tap, tap, tap, tap, and they’re making I know now they’ve got that perfect all the dots are lined up and it just great, you know, and they think oh, wow, I’ve completed this and what I want to say to them now sit the patient up, I’m closed. What’s gonna happen? [Jaz]It’s gonna change his posture related as well. [Dr. Glassman]Of course, so the trajectory changed. If you didn’t change your teeth. You didn’t change the position in your in a condyle of in the fossa. Your trajectory just changed So if were your posture changes in terms of your head and your entire head and neck, this was brought to us when we had Mariano Rocabado, from Chile, spent a week in my office and went over this. And he explained it in detail and showed us and we actually took cervical films of my patients with before and after treatment, and because I had taken them all before, and now these patients with open bite came, they took new ones and all of a sudden, each and every one of them, we saw an improvement in their in from their khyphotic curve toward more normal lordotic curve, and all of them had the anterior open bite. [Jaz]That’s amazing. And that’s another great thing you’ve taught me because I actually learned about the Rocabado Pain Map. Maybe in February actually. So it’s amazing how that’s coming back. Is that something you use in your practice [Dr. Glassman]We use Mariano’s exercise program, or attempting to strengthen ligaments? It’s brilliant. And some of Mariano has concepts in terms of joints. He spent a little more time lately with some of our neuromuscular friends. And I think he’s, well, I’ll leave it there. [Jaz]Okay, thank you. Okay, so it comes to conclusion that through the mechanisms, you described, changing trajectories that AOBs can happen, but the mechanism is not over eruption. [Dr. Glassman]And keep it as also keep in mind that the anterior open bites have been recorded and happened with forward arch, I mean, they just [Jaz]Oh, yeah, my principal, though, the worst one my principal ever had it on was a significant one from a Michigan splint. So it can happen from any splint, really. The types of patients I avoid delivering AMPSAs to are people who yet have a minimal overbite, already asymptomatic that, just like you said, and also the other one I like to put in there and tell, you know, tell me what you think about this is people who, when you tell them bite together, they say which bite like they have, like, they don’t have a well defined MIP they quite warm, they sort of don’t have sort of a good interlocking. Is that something that it could be a thing? Because that’s something that I love, you know, try and avoid, because I somehow think that in that patient, you might get more of the sort of slipping up like always changing trajectory, as you describe it. But I would have before this conversation, I would have said condylar repositioning, but obviously I see what you mean. But is that one to be avoided? Is that? [Dr. Glassman]I don’t know. I did so, I don’t know, that raises a really good, that’s a whole another discussion that we can have in you know, in our course, we spend a little bit of a significant amount of time talking about occlusal dysphasia. And, and the concern for, which means a patient who has become hypersensitive or aware of their bite, and how we create that. And you know, so how do you deal? How do you deal with the patient that comes in and says, Dr. Jaz, I have two bites, can you help me? Or Dr. Jaz, my bite’s not comfortable, can you help me? I’m only I know that we really don’t have time to go into that, Jaz in detail. But I always say the last thing you want to do with either of these patients is even look at their bite, even evaluate their bite and God forbid, change their bite. So and yet you can’t help them. So we go over we teach that because that’s really an important extremely important there’s not a dentist that I know that hasn’t dealt with somebody hasn’t walked in and said you can you help me doc, my bite’s just not comfortable. And how you deal with that. I don’t mean to be you know me, I’m not this is not I don’t believe in mama drama, I hate it. But I will tell you how you deal with that has the potential to save someone’s life. That’s how important this can be. [Jaz]Brilliant. And I just asked two more questions not because I think we’ve answered the main question about anterior midpoint stop appliances, over eruption which keeps on coming on and on and on. But I want to say is an anterior midpoint stop appliance, Are you concerned about its long term use? [Dr. Glassman]So that’s a real, that’s really interesting, because we [Jaz]by long term like years. [Dr. Glassman]It is true and we hear this all the time. You know, some really good instructors in prosthetics. And it’s very common for them to say, well, you can only use it in a muscle issue, not a joint primary joint issue. And of course, Jaz. Why do they say that? Why would they say you can’t use it in a joint primary joint problem? [Jaz]Because they think that it will impinge on the retrodiscal tissues eventually, if they think that the condyles will be driven backwards, right? [Dr. Glassman]So to please do me a favor, and don’t let the guys at s4s Matt Neel, know how much you know Because otherwise they would never pay that straightened me all the way over, they would just hire you. Yeah, absolutely. So there could there they’re there the literally concerned about. So they can’t use it in a primary joint for that reason and as a temporary a plan. So why do they say a temporary appliance? Because otherwise long term, we’re going to develop the supra eruption, and in their way, [Jaz]and also I’ll add to this, that it’s a temporary appliance, because then you won’t get through the ffull mouth rehabilitation to get it? I mean, I know, I know, that’s really naughty. But I feel as though you know, that is the other side of it. The ugly side of it is that, you know, these splints could be done in patients in pain instead of Oh, I think there’s full mouth rehabilitation, pain, well, actually the splint will has it’s role as well. And maybe, you know, [Dr. Glassman]So let me address that because I think you just hit something extremely important. And that is, we are talking what I call the restorative pain, disconnect. Now, this is not mean, people, again, so readily misinterpret this and think that I’m saying that there’s no relationship between occlusion and occluding, and pain dysfunction. Of course, there’s a relationship, the all my goal is the keystone of my treatment is not not let those teeth touch at all. So yeah, if I’m trying to keep the teeth apart, then clearly them being together creates a problem, though, our problem in dentistry is that we assume they are always together, we think of teeth, were trained to think of teeth as together. So we want to look at when they are together, and then keep them from getting together and then reducing the forces and allowing God or Darwin to heal. So but what often happens is that there’s this, this connection, I’m going to put in an appliance that’s going to tell me where this jaw has to be. And now I can do 36 crowns. In order to put the jaw were supposed to be now you people often say very, that’s ridiculous. They’re only 32 teeth. And I said, I know. But if they can do 36 crowns, they will. So yeah, there’s so our concept is that we don’t do restorative therapy to help our patients. We help our patients so that we can do the restorative therapy they want or need. [Jaz]That’s perfect. And I think that’s worth repeating, I will sort of copy and paste that snippet and say it again, because that is the real crux of it. That’s awesome. And I just want one more question now. There are a couple of occlusal camps whereby Some people say that actually, all these studies show that during mastication, and while we consume our foods, our teeth do touch together. And there’s another camp that say that actually, when we’re producing the bolus itself, our teeth do not touch together. And I still don’t know the answer. Do you know the answer? [Dr. Glassman]Yes. [Jaz]So they do together? [Dr. Glassman]No, you asked me if I knew the answer. [Jaz]Okay, so can you please shed the light on that? Because, you know, what is the answer? Because I hate this, two viewpoints. I’m pretty sure I can give you two papers where they argue different things. [Dr. Glassman]Right, exactly. So here’s my question, no matter what the answer is, explain to me how it matters. [Jaz]Okay, that’s a really good question. Let me think about this. It matters so that next time this debate comes up that I’ll have the right the right answer. Otherwise, [Dr. Glassman]Let’s go back here. So let’s assume that they do talk. The question is, what does that mean, then, and how do they touch? And how does it matter? So one thing I will tell you, let me ask you this. If they touch will they touch in MIP? [Jaz]See that I I’m pretty sure myself I mean, from what I read is no, we don’t fully get into MIP, Am I right there? [Dr. Glassman]MIP!, If you had a P in your in your on your right side, you’re no longer in MIP. [Jaz] Correct. So if there’s any if there’s something between the teeth you can’t reach it might be now you take a normal bolus and you put a normal bolus in between your teeth. No, And not only that, you’re when you look at the masticatory cycle, you look at an elliptical pattern of 19 to 21 millimeters that has that doesn’t even approach you know, this concept of fencing, functional fence. When you think about it, the role the teeth play in our masticatory cycle is next to zero. Whether you’ve got flat cusps, whether you got deep cusps, you’re going to chew like a cow or like a rat. Oh, you kidding. There’s, there’s a must, there’s a functional generator that controls our pattern has nothing to do with our teeth. And then as soon as you add bolus, the angles of those cusps are next to meaningless. So the answer is yes, they can touch in some inclined plane is somewhere along the line, they don’t touch with any force or with any duration to they can’t do that create the damage that is done during parafunction. And so so while it depends upon the patient’s adaptive capacity, if their capacity is so low that any contact, any increase in EMG levels, can set them off in terms of any of the components of the structures, sure it on those patients, we tell them, you know, you got to eat softer foods. But the vast majority of are patients with temporomandibular joint issues, we tell them, you can eat whatever you want,as long as it doesn’t hurt you. If it hurts you that signal to tell you, you shouldn’t be eating it. But what you can’t do is sleep without my appliance, because that you can’t control and those forces are far worse than the forces you’ll be experiencing during function. [Jaz]Excellent. And what percentage of people display or exhibit paraunction at nine times? You know this one? [Dr. Glassman]Yes. So if we look at the literature will get anywhere between 8 and 80. So you get so so so the literature is very, very dispersed on this, here’s my question to you, you’ve got the hardest structure in the body on the upper arch. And then on the lower arch. You see wear patterns when these teeth. You tell me what happened? How can we lose the tip of a canine? How is that possible? When we know God, or Darwin put one there. So if one is missing, or we see wear patterns in teeth, there’s a firm suspicion that that patient either is bruxing, or has bruxed, remember, there is no timestamp here. So it doesn’t repair itself. So the patient may have bruxed and may or may have stopped. But we know somewhere along the line, there was there’s a history of parafunction, you can’t use a you don’t have the intensity or the duration to alter two surfaces. Now, in the United States, there’s this whole thing called occlusal disease, this discussion of you know, the United States and blaming all of us dentists were all horrible people because we are not diagnosing occlusal disease. And we’ve got to restore and repair all this occlusal disease. And you know, in our course, we spend a lot of time looking at all the factors of the craniomandibular system, and putting the teeth in perspective. And understanding that, you know, you can get wear patterns on teeth and if you don’t have any other signs or symptoms, and you’re not concerned about the wear patterns, and the patient’s not concerned about the wear patterns. So be it. You know, if we don’t, you know, with that’s not you haven’t done a horrible thing, by discussing it with a patient. And if the patient doesn’t want anything to do with it, you know, isn’t concern, we shouldn’t I don’t know of many people that have died of tooth wear, and, or even aesthetically, major issues. And if you want, and if you want to restore the patient wants to restore them, then we can do that. But darn, we better do all we can to protect what we have restored from the forces that created the problem in the first place. [Jaz]Brilliant. Dr. Glassman, thank you so much. I think I’ve got lots of awesome content here. And I think that’ll really answer the question about the anterior midpoint stop appliances and over eruption. Is there anything, any final comments? Obviously, I’m gonna include information about your course, which I think everyone should go to, because I think it will really rewire your brain. And it was so powerful for me and my career trajectory. Is there anything that you’d like to add? [Dr. Glassman]The only thing is that I want to make it clear that because we’re looking at things that are different, doesn’t mean that there’s the fear that what we’ve been doing up to this point has been wrong. It may be that it has been right. But it may be right for reasons different than we once believed. And that we shouldn’t be afraid to ask the questions so that we can get better at solving more problems more conservatively for more people. What I’ve learned is what general dentists are capable of doing is massive that for a long time what I realized is that when I started using these anterior midpoint stop appliances, what I found was that patients would come to me and with a series of symptoms and problems, and we would start them on their appliance therapy and three weeks, four weeks later, they’d come back and we say, Okay, now we’re going to start with all the other supportive therapy that we had mine. And they look at me and they say why? I’m better. And what I realized is that dentists can do that. And then they can refer to people like myself and other oral especially oral facial pain, people who have learned their practice oral facial pain, and then for support of therapy, they can go there for that. So that support therapy, but it’s amazing how much they can accomplish in their own offices, once they get over the fear of failure. Jaz’s Outro: So thank you very much for listening, everyone. As you can see, I really enjoyed having Dr. Glassman on the show today, was really useful, great knowledge. And so we have the answer. Anterior midpoint stop appliances will not cause anterior open bites because of posterior over eruption per se. However, in a small percentage of cases, with any appliance and including anterior midpoint stop appliances, you can get anterior open bites. And the mechanism is not posterior over eruption, it’s a change in the trajectory of how your teeth come together. And there are certain sort of risk factors that might predispose you to having an anterior open bite, and that’s covered really well, obviously in our conversation with Dr. Glassman. And the thing to remember, I suppose, is as Dr. Glassman says the punishment should not be worse than the crime. So try not to use it in asymptomatic cases or those with minimal overbites. I tend to use them for my pain patients or those I want to deprogram diagnostically. Well, thanks so much for listening. I just want to mention before you go about the Dentinal Tubules Congress in October, if you haven’t already booked, what are you waiting for? It’s something that you know, I look forward to every year and I hope to see you there. It’s got some great workshops including occlusion, complete dentures, preparation where they sort of scan the teeth at the same time you get like instant feedback. So all these workshops still aren’t available at time of recording. So check out Dentinal Tubules Congress in October, and I look forward to seeing you there. I’ll put the link in the bio. Thank you.

Is this a silly question? Now that I know the answer, perhaps so. But I do think that many students and GDPs fail to see the main role of Class I molars in a pleasing smile… I am joined in this episode by Dr Mohammed Almuzian, Specialist Orthodontist and one of the best educators I have ever had the pleasure of learning from. Need to Read it? Check out the Full Episode Transcript below! What we cover in this podcast: What is the significance of Class I molars? How you can calculate what the overjet may be if you carried out alignment only orthodontics in fraction class molars Is there ever a suitable situation to accept a compromised orthodontic result? Does it always have to finish in Class I molars? As promised in the podcast, here are some helpful links: A guide for Orthodontists and Dentists for treatment planning Orthodontic cases: http://www.aviosanalyser.co.uk/ Dr Almuzian’s academy website: https://www.orthodonticacademy.co.uk/ The FAMOUS Almuzian notes which have been, to date, downloaded more than 350,000 times! https://www.orthodonticacademy.co.uk/almuzian-note Click below for full episode transcript: Opening Snippet: It's not the fact that we're chasing after the class one molar, it's because we're chasing after a good stable, pleasing looking smile. And that is led by the posterior... Jaz’s Introduction: Hello, everyone, I’ve got a really good episode for you today. There’s some useful links and resources that if you want to access them, you can download the show notes from www.jaz.dental That’s Jaz with one Z. That’s jaz.dental. And under this sort of episode title, it’s like a blog post you can download a PDF version there’s quite a few good links that Dr. Mohammed Almuzian shares today. So you can check those out on the website. So some of you know already I’m doing a diploma in orthodontics with ACE which is Academic and Clinical Excellence orthodontics. So it’s ACE orthodontics, based in Manchester, and the specialist and the educator or mentor for this diploma is Dr. Mohammed Almuzian, who has been just a beacon of energy. He’s been a fantastic educator, and I really wanted him to appear on the show, so he can share his orthodontic gems, and I thought just where a better start. Then one of the pressing questions I always had when I was student or with my restorative background and mindset to ask why our class one molars important. Why are orthodontists dare I say so anal about class one molars. Now if you’re someone who’s listening to this, who is an orthodontist, or someone who is well versed in orthodontics, you’re probably thinking, what the hell is jaz all about? Isn’t obvious why class one molars are important? Well, actually, not quite, I don’t think is that obvious. And I think some of the points raised today is actually I’m hoping will help a lot of people, a lot of gdps. And maybe students think, oh, that suddenly makes sense, I want something to click, I want the penny to drop. So for example, in my restorative background, my previous sort of rehabilitations or veneer cases, I wouldn’t actually always look at the molar classification. If I’m only working anteriorly, maybe slightly increasing of the occlusal vertical dimension, I wouldn’t always like record or mentally note the molar classification. And I think that’s a mistake. And then now obviously, after doing this diploma, I appreciate the molar classes, much more due to reasons that it will shed some light on why that is today. And also I appreciate faces, I look at faces long face, short face. I really look at that much more now as well. “Do they look brachyfacial? Have they got large masseters? So really learn to appreciate faces after doing the diploma as well. So what me and Dr. Mo cover in this short word valuable chat is, what’s the deal with class one molars? Why is this classification so important? Why do we need to sort of appreciate the molars? What does it actually mean? How can you mathematically calculate the overjet once you align the teeth based on what the molar classification is? So it’s pretty cool thing that you know, once you get confident, and you can tell patients, okay, if we just simply align your teeth, you will have a seven millimeter overjet. This is what this looks like on your models. Is this an acceptable compromise fro you? So and that gives you another sort of consent point. And it makes you look very clever that you could actually predict how the teeth will change. Some of those who maybe use a 3d conject software can have already got accustomed to this now. And interesting. We also discuss in which cases can you accept a compromise result in orthodontics? Give me some feedback, let me know how you like it. And before we get into that, I want to share with you my Protrusive Dental pearl for today. And basically, it’s one of my favorite sayings. And it’s a great quote, and it is basically ‘how you do anything is how you do everything.’ That’s how you do anything, is how you do everything. Basically, once we qualify, our standards can drop so sharply, so quickly without us even realizing it’s scary. And I think we all know what you mean, there are standards, the little things that, you know, we’re sort of strapped for time, you’ll leave something, you know, a restoration high or when you’re placing a matrix band, and you know that, you’re getting a little bit of seepage anything, it’ll be fine and you know, just restore anyway, so our standards can drop so quickly, patients will be fine, usually 99% of time, restorative work can be quite successful, even if it’s done poorly, unfortunately. And something that you know, you can get away with, but in the long term, you know that that’s damaging the patient or it’s not an ideal result, or it’s not the way that we were taught at dental school. So what you could do is if you focus on one thing, just one thing per week to increase or up your standards, so that by the end of the year, you have made, you know, a monumental shift towards working at a highest standard of care. So how you do anything is how you do everything. Remember that when you’re cutting corners, try and be as textbook as possible where you can. We are all learners we are all students, but our aim is to get through dentistry fall in love with the real minutia and the details of dentistry, and that’s one thing that’s, I think it’s quite important when you’re passionate dentist, falling in love with the very little details and getting satisfaction from mastering those. Hope enjoy the episode I’ll join you for a debrief at the end. Main Interview: [Jaz]So firstly, I would say, Dr. Mohammed Almuzian, thank you so much for joining me on Protrusive Dental podcast, I’ve been wanting to have you on for a long time because to me, you’re one of the best educators I’ve seen not just in orthodontics, but but generally I mean that genuinely honestly, you know, me and the other doploma students were very raving fans of yours. And I needed to get you on the show. Because I think the way you explain certain things will really, really empower and help gdps and that’s what today is about. But before we get into the meaty bit, just quickly can just introduce yourself, tell us about yourself, what’s your interests are and where you working now? [Mohammed]Thank you so much, Jaz. Well as it’s my pleasure to meet you. You are one of the brightest students, the diploma, one of the smartest one. And then pleasure to and it’s my pleasure to be with you here. My name is Mohammed Almuzian. And people call me Mo. I’m a specialist orthodontist. I’m on an electronic University of Sydney, research fellow at the University of Edinburgh. I work as a specialist orthodontist, in London and in Glasgow, and also I teach civil diploma across the UK. And also I teach and supervise some postgraduate students overseas in the Middle East, Australia, and in Germany as well. [Jaz]One of the things that you’re quite famous for I mean, there’s, you’re famous for lots of things, especially you’re heavily published in peer reviewed journals. One thing that you’re really famous for amongst MO Students or orthodontic students, is you’re famous Almuzian notes. So if you are interested in learning delving deeper into orthodontics, I mean, I know Mo teaches on lots of taught diplomas and courses, but even just to read around all these notes that is simplifying for learning, how can people access the famous Almuzian notes? [Mohammed]Well, it’s accessible for free online, they are available on the Facebook, on SlideShare. It’s took around seven years for me to write them up. And I post them for free and to share it with our colleagues. And now I’m at stage of condensing them, rewriting them, proof editing them and make them in a free book, which is accessible through Kindle app. And it will be kicked updated, as shown. And just let you know, that’s because I have an access to the statistic of slideshare. And I can see how many people access and like or download the notes. I found that in the last month since 2013. Until now, they have been downloaded almost 350,000 times. [Jaz]You can’t see this right now. But my jaw literally dropped when he told me this. [Mohammed]I can’t see that. [Jaz]That’s huge. Congratulations. That’s very good. This is exactly what I want to have on the show. So let’s get to the meaty bit. Okay. I’ve been on a few short orthodontic courses before, okay. And, you know, I’m still in the very early stage of my journey of learning orthodontics, I think orthodontics very, very complex, I think personally, and I think Dr. Mo has helped to simplify a lot of the aspects and make me into a safe beginner who can use the evidence and come up with reasonable treatment plans that are safe and effective for patients. And that’s the [Mohammed]and this is why we developed the safe more technique for treatment plan, which is an chronium help that specialist orthodontist or dentists, to structure their treatment plan and come with very structured and thorough treatment plan, [Jaz]Can I put a link to that on the book? [Mohammed]Yes, absolutely. Actually, I already developed the beta phase of an app where the clinician can go through and add questions and answer and after that, it will give them a treatment plan. It’s not ideal. It’s not a place wherr you [Jaz]It’s a guide. [Mohammed]It’s a guide, it’s a set templates. [Jaz]If that’s available, I’ll put it whenever it is available. I just put it on the show notes and then you can download that. So one thing I want to ask is why and this is a question that gdps might be embarrassed to ask okay, but why are class one molar so important? Right? Because I’ve asked some few questions on a few courses, especially if you let’s say STO or anterior alignment orthodontic courses. And we think oh, if he sent an orthodontist it’ll take two years course treatment they’ll get within class one what’s the point? Why the midline have to be coincident? But I think when I when I came on this course, and I realized something I don’t want to ruin it by saying because I think you’ll say you’ll get more justice, but class one molar Okay, so someone says, oh, why is class one molars important? What’s the point? Okay, how can you simplify the understanding for GDP? [Mohammed]Well, we as a specialist orthodontist, we are not looking to achieve a class one molar all the time. But the molar relationship for us is a guide to guide the anterior teeth occlusion. So by achieving a class one molar relationship in a case where you don’t extract teeth, I mean, that’s in theory, you will get a class one incisal relationships. And in cases where we have a class two, for example, class two molar relationship, this and missing tooth in the upper, in theory, you will get our aligned teeth. So it’s very complicated to explain it in this short interview. But the molar relationship, whether it’s class one, or class two, or class three doesn’t make any difference in terms of stability, in terms of aesthetic, or in terms of that function. There are actually a guide for us as a clinician, whether we are a specialist orthodontist, or dentist with enhanced skill in orthodontics to guide the anterior teeth. So it just give us a view how the teeth will look like at the end of treatments, [Jaz]Perfect. And for those who are very simple minded, like me, the way I when Mo taught us, and he went to much more detail than this, obviously, what’s possible in this short audio show, but basically, if you’ve got someone in the way that if you’ve got someone in half a unit class two Molars, okay, and they’ve got a, let’s say, a class two div two and you know that they’ve got a bit of crowding anteriorly, you can tell the patient, why it might be a good idea to treat, to get treated more comprehensively, because you could say already that because they’ve got a half a unit class two molar. That means and please correct me if I’m wrong. So we’ve got half your class two molars bilaterally, then that means that both molars are ahead, by half a unit, which is roughly about two and a half four millimeters, right? [Mohammed]Yeah, assuming that you have full set of teeth and [Jaz]So therefore, you know, that your overjet if you were to simply align everything, and level in line, everything would be four millimeters more than the class one. So it’d be you’d say to patient Listen, you wouldn’t even say it this way. But you would be able to show them that your upper teeth would be ahead about six millimeters. [Mohammed]Yes, because our aheads by four millimeters [Jaz]The whole set. [Mohammed]The whole set of the teeth are aheads by four millimeter. This means that after you straighten the teeth and align the teeth, then the anterior teeth will reflect what’s happened posteriorly, and will sit forward by the same amount as the upper teeth are sitting forward in relation to that lower teeth. I’m trying to use non jargon words here because maybe we’ll have people who are not dentist or hot Angeles in dentistry. So when you have half the class two molar, which means that the upper molars are sitting four millimeter ahead of the normal position, then when you align the teeth then the anterior teeth will become four millimeter ahead. [Jaz]And it sounds really simple when I look at it now now that I’ve been through most of your diploma, but at a time when you explain this, it just clicked and I think all GDPs and a lot of GDPs probably in haven’t thought about it this way. Actually, it’s the molar being in class one is not the what we’re aiming for. We’re aiming for a pleasing appearance in a good occlusion with good cusp to fossa relationship with good overjet, good overbite, these are the things and these are guided by a molar relationship, it’s not the fact that we’re chasing after the class one molar, it’s because we’re chasing after a good stable pleasing looking smile. And that is led by the posterior. [Mohammed]And just to remind you know, and the molar relationship, it’s one of the first key of occlusion and Andrew’s six keys of occlusion. So achieving class one molar when you have full set of teeth is essential to achieve incisal relationship. Assuming that you have full set of teeth, and to simplify it in another way, if you have two upper teeth are missing, then ideally should your molar relationships should and in full unit class two what’s called therapeutic class two in order to achieve the class one incisor and if you have missed two missing teeth in the lower then your molar relationship should be class three in order to achieve class one incisor relationship and just small comments about half units well as orthodontist or as a dentist who has enhanced the skill in orthodontics and a good educational background in orthodontics. This is our aim achieving class one, class two or class three if there is a missing teeth or not, but half units or flexion. Class two or class three is not an ideal because this means that the patient are biting cusp to cusp and this is not stable in terms of occlusion, it might affect the long term prognosis of the health although the evidence are weak. It might effect that TMD although the evidence are weak, but we try to eliminate these even if there is a small out or weak evidence [Jaz]When you see class one, a perfect class one case study models. You see that how everything intercuspate so nicely. [Mohammed]Absolutely and this is why they are locked together I’m guessing that the teeth will get stable [Jaz]Yeah, but even in a class two, full in a class two things actually intercuspate nicely as well. So in these full units, they meet well, but half units, like you said it’s not quite well into intercuspated. [Mohammed]Absolutely. [Jaz]So which leads nicely onto GDPs Okay, a lot of times get this in, especially in the UK where dentists, GDPs can practice orthodontics, in some countries, they can’t. And I know in Singapore right now, given me some news that in Singapore right now, they’re going through a lot of appeal at the moment the GDP are upset, because the specialists on to suggest that GDP is need to limit their scope of practice, that they may not be able to do orthodontics anymore, they may not be able to do a lot of what they do like implants, root canals, that sort of stuff, which is crazy. Let’s not get into that too much. But in this country where we can practice orthodontics, where is the place for compromise? In which case if you think it’s okay to compromise what I mean by that is, in which cases it might be okay to compromise within reason? And which count cases must use simply always try your best to get a comprehensive result? That’s not too unfair a question? [Mohammed]Yeah, let me let me rephrase the question. So you’re saying in which case we can accept a compromised result, well, always our aim is to achieve an ideal result, an ideal or normal occlusion or ideal occlusion and this means that good intercuspation of the teeth class one incisor relationship. When you say compromise occlusion it’s mean that you are accepting slightly imperfection in the occlusion may be increased overjet, may be reduced overbite, may be increased overjets or [Jaz]Yes, so all those things that you just said, except things will be aligned and the patient might look a little bit better, however, at the expense of overjet, at the expense of potentially overbite, at the expense of fraction class molar. So fraction class two fraction glossary, whatever, but it’s basically the social six are happy in that case. As an orthodontics, opinion and educator, in which case Do you think okay, it might be more acceptable, it might not be in the real world? [Mohammed]First of all, you should know that orthodontic treatment is most of the time is an elective procedure, it’s cosmetic procedure. So the evidence that is reduce the risk of developing Achilles has added a new paper has been published recently. And they said that there is no difference between straight teeth and a regular teeth. In terms of the straight and get in terms of the function, mastication, it has limited effect except when the patient has difficulty in mastication and chewing or incising food in anterior open bite. In term of the effect on their TMD and other factors has been proven by Luther Cochrane Review that there is no correlation between strated and good occlusion and and TMD in most of the cases. So what I’m saying is that’s why I said that orthodontic treatment is an elective procedure. Sometimes you need to waive the risk and benefits. And if you find that the risk of achieving comprehensive treatments or let’s say, a perfect occlusion class one incisor, class one canine and perfect intercuspation is higher, the risk is higher than the benefits then I personally as specialist orthodontist, and most of my specialist orthodontist colleagues, we do sometime and accept a compromise treatments when, for example, the patient has some periodontal problem or I’m not saying you should actually not treat a patient with periodontal problem, let’s say the patient who have a slightly short root. And if you move the teeth significantly to correct the overjet, significantly, this means that or two that you want to collect the object to the ideal. This means that you will expose the patient to a higher risk of root resorption because there are at least a systematic review by Cochrane that if you move the teeth over a long period of or long distance, and over a long period of time, you’ll expose the patient to higher risk of root resorption. Okay, so maybe we’ll accept just aligning the teeth accept compromised overjets and pleasing the patients and assess. [Jaz]As long as it’s an informed discussion with the patient. This might be a way to go because it might mean that might be less issues with the you know, your teeth breaking down, root resorption, losing your teeth, or reducing the prognosis of your teeth base. I wouldn’t say like that to a patient but in terms of a lot of dentists, listen to this. So in those cases, where the risks may be greater than a benefit of being completely comprehensive getting complete overbite and overjet reduction, but at the same time you still need to meet the aesthetic goals because it is an elective procedure. [Mohammed]Absolutely. But if you are going to achieve a compromise treatments and if you are whether you are a specialist or you’re dentist with enhances skill and it is your obligation according to the GDC requirements or GDC advice, which is actually a Montgomery is to offer all the patients all the treatment options including not treatments, compromise treatment and comprehensive treatment and you should be able actually to provide all of these options in case the patient decides to change their mind during the treatments okay? And secondly, if you are going to offer a compromise treatment you should discuss the side effect of having compromise treatment. You will tell the patient Listen, I am going to tax your teeth I call when you do orthodontic treatments, I call taxing the teeth. Okay and every time you tax the teeth that it will become, the road will become shorter and if the patient decides to go through the compromised treatments, they will have, their teeth will be taxed once, if they change their mind after a couple of years, then the teeth will be taxed again and they become shorter. Plus, you should inform the patients about alternative options achieve treatment plan with the risk and benefit of the alternative options. You should also inform the patient that there might be, the teeth might be unstable if you are not achieving a good intercuspation. If you are accepting a compromised overbite and overjet you should make sure that you have a good retention strategy in this case, because you know, stability, good intercuspation, a comprehensive result sometime help according to evidence to maintain the result. In your case when you have happen class two molar or when their teeth are biting cusp to cusp or when the teeth are not meeting in a good intercuspation. They are free, they are they can slip forward. They are not locked down. So you need to inform the patient about all the risk but there is no harm. I do a lot of compromise treatment. I don’t call it STO, I don’t prefer to call it short term orthodontics because it’s not a science. Okay? It is alignment phase of anterior teeth. And this is of course, if the risk is higher than the benefits of achieving a comprehensive result. Of course it should involve the patients in this decision phase. [Jaz]That’s fantastic. I really loved the taxing. The taxing was great gem. So we’re running out of time. So I’m just gonna just do one more thing. What do you think about this last bit? What do you like this phrase about children to treat them idealistically, adults treat them realistically. Who said this you know? Otherwise that is I always hear it I really think it’s a nice thing [Mohammed]I think we should be, see Jaz when I finished my first orthodontic treatments, orthodontic training 19 years ago we our treatment was a clinician centered treatments. So we want to please ourselves more than pleasing the patients we want to achieve everything perfect class one incisal, class one canine and we move the teeth you know behind their envelope and it’s took ages for the patients Okay, we spend a lot of time achieving something minor. Now the treatment has been moved and become a patient centered so instead of for example, if you have buccal impacted canine why I will be bothered of extracting the premolar or bringing the canine down, the canine I will come with a receded gum which will take ages and the patient doesn’t care about having a canine or premolar as far as they have well aligned teeth and nice a smile. So what I am saying is is that you should we should actually aim to achieve a patient treatment that please the patient first within reasonable justification okay and we should be realistic rather than idealistic and maybe just another comment about why we sometimes we can be a idealistic in children is because we have a lot of options in children. We can expand the jaw, we can move the mandible forward, the teeth not the jaw actually. We can do a lot of things, teeth move faster. Okay, a study 2018 and show that the teeth move faster and patient’s compliance is better. Okay? [Jaz]Distalization [Mohammed]Distalization. A lot of options. Okay. We can move the teeth in the 3d in bigger envelope than in adults. [Jaz]Profits envelopes? [Mohammed]Yes. Well, profit envelope is a wonderful and good. But for children the envelope of doing orthodontic treatments on razor is bigger. Yeah, so we can achieve a lot while in adults. You know, the discontinuation of treatment in adults is 30% compared to children, which is 12% because adults are decision makers, they can stop treatment now, because their pain is higher than children because the pain releasing factor is higher end adult children, [Jaz]I didn’t know that. So 30% of adults discontinue to finish a bit earlier maybe [Mohammed]Yes 20 to 30% a day there’s discontinuation of treatment at some stage where they’re changing the plan to get shorter treatments or just abandon the whole treatment plan. And this is because they suffer from a lot of pain, the tooth movement is faster so their compliance is dropped after a couple of months and because the pain is higher and because we are decision maker we get bored you know if I put fixed appliance now I’m sure that you’re using an Invisalign. And you start now complaining last time when it drove me you start complaining about your treatments. If you are a 12 years and you are my son, I will force you to use fixed appliance okay? Because their motivation in children is external. An external and internal in adults is main internal and you can make a decision and this stop the treatment now. [Jaz]Brilliant. [Jaz]Well, thanks so much. Thanks. I really appreciate. It really helped all the GDPs [Mohammed]My pleasure, Jaz. All the best. And all the best for the gdps as well. [Jaz]Thank you Jaz’s Outro: Okay guys, I hope you enjoyed that. Let me know if you did. And also if you like my episodes, then please tell a friend and also sign up for their newsletter on my blog jaz.dental, so that any episodes that come out can get email notification as well. I’ve got some other really cool things lined up and lots of guests and some solo ones as well. So I’ll catch you next time. Thank you so much for listening.

I am joined in this episode of Protrusive Dental Podcast by the likes of Harjot Bansal, Mahul Patel, Dhru Shah, Catherine Tannahill, Lourens Bester, Kiran Juj and Sunny Luthra. Yes, that’s an awful lot of guests! It HAD to be done to help answer such a monumental question that crosses every Dentists’ mind: Should you specialise? My main guest, Harjot Bansal, is studying his MClinDent in Prosthodontics at The Eastman (London). He is always happy to help and his instagram is @harjsb Need to Read it? Check out the Full Episode Transcript below! Protrusive Dental Pearl: Show your human side! This will help calm your patients down and create rapport. Here is the photo, as discussed in the podcast, I have in my surgery which has been eye-opening: Dental Elective April 2012, 1 hour from Da Nang Here is what we discuss in this episode: Why specialise? The true cost of specialising – think loss of earnings! Financial planning for specialising How to know which speciality is right for you? Endodontics? Perio? Prostho? Ortho? Can you be fulfilled and skilled as a General Dentist? Is it right for you? A massive thank you to all my guests on the show! Music credits: Life by KV https://soundcloud.com/kvmusicprod Creative Commons — Attribution 4.0 International — CC BY 4.0 https://creativecommons.org/licenses/by/4.0/ Music promoted by Audio Library https://youtu.be/jH8ryRw1cWgBedtime Stories by mezhdunami. https://soundcloud.com/mezhdunami Creative Commons — Attribution 3.0 Unported — CC BY 3.0 https://creativecommons.org/licenses/by/3.0/ Music promoted by Audio Library https://youtu.be/WCYCRged0r0Escape by Declan DP Music https://soundcloud.com/declandp Licensing Agreement 1.0 (READ) http://bit.ly/DeclanDP_MLA1 Music promoted by Audio Library https://youtu.be/PiQK_KYirio Click below for full episode transcript: Opening Snippet: Don't think you need to specialize to be good per se... Jaz’s Introduction: Should you specialize? Do you ever regret that perhaps reach your full potential as a dentist because you didn’t become a specialist. Or maybe you can’t stand being a GDP and you yearn to limit your practice to specialize in something. Or maybe you love the variety and you don’t think you could do the same kind of stuff day in day out. And the thought was puts you off. We interview today with Harjot Bansal, who’s doing his MClinDent in prosthodontics at the Eastman. And it’s great to have a perspective in terms of what it’s like in terms of commitment, time, money, intensity, and all those things that so if you’re thinking of specializing that, and that could be quite a helpful thing to consider. I’ve also got some gdps, and people with special interests, given their two pence about the subject, it is a bit like a debate, you know, I’m a little bit biased towards team GDP if you like, because you know, someone has to represent gdps, I will be sort of having a debate with Harjot and the guests to sort of gather different perspectives. The Protrusive Dental Pearl for this episode is to show your human side to your patients. Okay? So I sort of discovered this by accident where six months ago, I changed my surgeries, computer desktop background to a photo of me on my elective in Vietnam, it’s a lovely photo op, I’ll put it in my blog post. It’s me with these Vietnamese children in a rural village and everyone’s smiling, I think I’m handing out stickers or something, it was just a perfect shot captured. When new patients come in the addition of that photograph really creates a warming environment. If you can find a way to make an icebreaker with your patients, then that’s always a great thing to do. So that has worked really well for me, I think when patients sit down, and directly in front of them, we have this big TV screen, it’s got the photo of me as a desktop background. They really feel at ease, and I can see it in their body language since I put this photo up. So I mean, you could use in lots of ways if you’re a hardcore Westham fan, have somebody in your surgery that shows that. Or maybe if it’s a photo of your children or loved ones, a framed photograph, perhaps, or maybe a photo of your pets. I think all these have a really nice touch, really nice human touch. And if you try this, you’ll see that patients will notice and it really humanizes you and I think as dentists, we really need that. So the pearl for today is to humanize yourself. It’s really, really powerful with nervous patients. Okay, so this episode is a little bit different to my last ones, I’ll be hopping from guest to guest, and I’ll try and mix it up to vary a little bit. Main Interview: [Jaz]Harjot Bansal, thank you so much for joining us on protrusive today, it’s been good to have you obviously, we’ve been friends for a while now. And I’m always liking your work on Instagram. And I know you keep us off, very busy, clinically, academically, all those things. So for those of you out there listening, you don’t know Harjot. Harjot, can you please tell us a bit about yourself? [Harjot]Jaz, thanks for having me on today. I am currently working in practice, and currently studying part time doing my prosthodontic training at the Eastman, which I started about six, seven months ago now. So I’m halfway through the first year, [Jaz]How many years this course? [Harjot]So it’s three years through the MClinDent. And then the final year is your MRD exams, specialist training exams, essentially. So for the part timers for myself, it’s three `days a week for three years. And if you’re a full time as you can do this full time, it’s full time five days a week, for two years. [Jaz]But that then you still even if you do a full time, you still need to do the MRD, right? [Harjot]Yeah. So there’ll be another it’ll be another year. Absolutely. [Jaz]Full time. Is that another year full time? [Harjot]Well, it’s not quite full time. I think you have a little bit less time where you actually go in but I end up seeing a lot of the full timers who are doing the MRD year in a lot. You know, they’ve got a lot of work to do. They’ve got patients to finish off the court, cases that we need to try and finish and lab work to do as well. So it’s pretty much yeah, it’s going to be either three years or four years. [Jaz]One thing I remember speaking to a lot of people in my journey from even as a dental student to where I am now as a young dentist is I’ve asked a lot of people about different postgraduate programs and one thing you constantly hear is that Eastman is just a different kettle of fish. Eastman is like, really hardcore, Like it’s, you know, the, for example, the cons conservative density, MSc was also known as the divorce course for example, you know, it’s really full on. Can you vouch for that? Is it really how did it, how it is? [Harjot]See, I think you need to tie you up with your personality as well. The first three months of the MSc in conservative dentistry that you just mentioned at MClinDent in prosthodontics, which I’m doing, they run side by side, we learn all the same content. They don’t do the removal stuff we do removable prosthodontics as well. And the first three months is super intense. It’s really it’s the Phantom head course, which involves learning a lot of different kind of prep designs and understanding your material sciences as well, understanding the laboratory side of what you’re going to be implementing on your patients. And it is just a lot to get on board. And there’s no doubt that I was the 9 till 10,11 at night. [Jaz]Yeah, that’s I’ve heard that see late at night, early in the morning. It just takes over your life for a period of time. [Harjot]It does. But you know, at the end of the day, I think it doesn’t have to be that way. There are people on the course you’ve got, you know, families, they’ve got kids, they are just really, really good at getting things done. You know, they’ve condensing the workload and learning efficiently and working well that they just are able to get things done. So it’s up to you as a person. You don’t have to be there. But there’s a lot of work there’s no doubt. [Jaz]Course a man who knows he needs no introduction, Dhru Shah, periodontists giving his input on why he specialized in and why it might not be right for everyone. And it’s all follows on from the transition to private dentistry, I think it was episode three, which is definitely worth it as got lots of good, great feedback and probably my most listened to episodes if you haven’t heard Episode Three, do check that one out. It’s got it’s full of gems from Dhru Shah. [Druh]I think people end up specializing for the wrong reasons. Most of the time. A lot of people have found in spoken to say, I don’t like NHS dentistry. In practice, I’m going to go and specialize. I don’t mean to specialize for that reason. And, you know, it’s been alluded that dentistry is a long career. Now, I ended up specializing because of what I enjoyed, I enjoyed this edge class, [Jaz]How long did it take you to figure out that that’s what you enjoy? [Druh]5 years, 5 long years, I was doing very long hours. So you know, six days of practice, six days in hospitals, Sundays, I did extra days with the maxfacts surgeons, eventually, I realized that. So I’m the only specialist who says if you want to do good quality dentistry, you don’t need to specialize. Don’t specialize if you want to do that, you’re going to spend shedload of money, your fees aren’t cheap, you’re going to be working in a system that is an ideal, which carries a lot of stress with it. And this goes back to our podcast when we talked about pain and pleasure, do not do this to move away from pain, go towards pleasure. So my advice to young dentists is to say, look, take your time, do a multitude of roles, perhaps stay in a practice for, you know, quite a few years and see your work coming back, understand it and then think do you want to really enjoy just one part of dentistry? Or do you want to be a practitioner who enjoys doing many aspects of dentistry [Jaz]And you can still limit your practice to a lot of things that you may choose to I’ll do, I won’t do endos, but I’ll do everything else. I know some practice to do that. And they haven’t specialized in one thing, but they’ve limited their practice to their own niche that’s fine. And that’s what that means. And the other thing I’ve been reading or listening to audiobooks for is their personal finance, when you actually think about how much you invest in terms of loss of earnings and how much you’re spending the fees. Okay, that money put into a mutual fund in a tax protected account something and the interest accrued in the stock in stocks or shares over the years and, and then the fact that once you do become a this, you know, all singing all dancing specialists, it takes that one complaint to ruin your life. That’s a completely different spin on putting on it. It’s very volatile. [Druh]You’re right, that’s why I said sacrifice is big for specialisms. So unless you thoroughly focus and enjoy something, specializing is something that you have to be careful about, don’t do it to move away from or run away from something, if you’re going to really enjoy it. That’s why you’re doing it because [Jaz]then it’s very rewarding, you know, as for you in all sorts of ways, once you’ve done it for the right reasons. [Druh]I mean, let me be honest, it’s a monotonous job for me, you know, 90% of my work through planing, understanding chronic pain patients, okay, maybe now it’s 70% is I sort of diversify a little bit more. But this is what you get. Are you ready for that? And financially, you know, [Jaz]And most endodontists if they’re not doing, you know, I suppose MTA plugs all the time. fancy stuff that they’re doing in the primary root filling of a broken down belly, restorable lower molar with a patient who can’t open very wide that’s why they got referred to you. So this is the real world is not all, you know, it shouldn’t fantasize at once. I’m a specialist, I’ll get happiness, you have to actually think about it in a different mentality. And then it comes back to mindset once again. [Druh]It goes back to mindset again, yes, but yeah, that’s my thing. [Jaz]What advice would you give someone when they are at that Crossroads where a lot of people think oh, I need to specialize to be good or that’s a pathway for me. [Mahul]I don’t think you need to specialize to be good per se. [Jaz]So that was Mahul Patel. Someone I really respect he’s in fantastic educator. [Mahul]We are in a long career. Right? We are on average in a 45 year career In my opinion, we start dentistry on average about the age of 23 or work towards, you know, our late 60s. 45 years of doing teeth is a very long time. My advice would be not to rush into anything too hastily. Because if we break down 45 years into thirds, the first third of your careers 15 years. The next third is another 15, which takes you up to 30 years. And then the last third is, you know, between 30 and 45 years. So I would say the early starts of one’s career, one should try and do as much as they can look at working in primary care, maybe look at working in secondary care to get different ranges of experience, like you have done, going out back into primary care, and then making more formalized decisions from there. [Jaz]And I really liked the way that he broke the long career down into little chunks, and how to think about each one. So that was a real nice way of doing it, [Mahul]The training pathways these days are a lot more clear cut, and they do allow entry at a much younger age. And that can be, you know, to an advantage of a younger dentist looking to go into specialist training because the pathway is there. So as long as they’ve carried out the right requirements, can tick all the boxes on their CV, go in at the interview, do well, they’ll get accepted, hopefully in their center of choice. But I think you don’t necessarily have to be a specialist to be good at anything. There are plenty of general dental practitioners who are excellent clinicians. And that’s one way to look at it as well. [Jaz]He works in referral practices in the West End and Walden some of his courses are just fantastic. Focusing around splint therapy, tooth surface loss, rehabilitation of the worn dentition Harjot man ,when you’ve made a conscious decision that you’re going to immerse yourself in a subject and you’re paying the fees, and you’re there. You know, I think a lot of personalities were like, right, I’m here. Now, let me just max it out, do the do the most I can. But obviously, for those who can’t, because they’ve got families and whatnot. And there’s so much you can do then I suppose they just do the most they can within reason. Without upsetting the balance. [Harjot]Yeah. Exactly. And the thing to remember is, you’re quite right, when you’re paying that kind of money, you want to really take everything away from me that you can and I’ve definitely been back in on the weekends and after work about to come in just to finish some things off. But I mean, it’s part and past, you know, what you’re getting yourself into, and it is really intense. And you just got to like you said, You’ve got to immerse yourself into, you’ve got to enjoy it as well at the same time, right? You wouldn’t be doing it if you hated it. And there are days where you just feel like oh my God, I’ve got so much to do. But actually what you find is, is that after the initial three months, then comes with the kind of reading that you need to do all the seminar work, which is really intense. [Jaz]If you don’t mind roughly, what kind of fees would you be looking at, if you’re thinking of specializing and to be honest with you, it’s not specific to Eastman, if you want to do the perio MClinDent, or no Queen Mary’s, you’re paying roughly similar sort of fees, is that correct? [Harjot]Anywhere between I’d say the 12 and kind of 15 to 18,000 pound mark is what you’d be paying for any of these kind of mono specialty, like you said, You’ve got to get the most out of it. It’s important to keep busy and to do as many cases as you can even if you feel like you’re overburdening yourself or you’re taking more time out to do it. You know, you’re there for a reason. You know why you’re there, you’re making loads of sacrifices, not just financial, time spent with family and doing other things, social things, just make the most of it and just immerse yourself in it, you know. [Jaz]So it’s a fees. That’s per year, obviously. If you listen to the USA episode that I had with Kristina, they’re paying, you know, far more than that in the US for speciality programs. So you got to take that into account. But also then on the flip side, there’s the three famous letters, LOE, loss of earnings, okay? So when you’re not there, doing teeth in a practice, and you’re doing it in a university setting or a hospital setting, then there’s a huge element of loss of earnings, and you need to be able to sit down and you know, speak with your accountant maybe? Is that a good idea to do to see if it’s possible to make a make a plan, financial plan? [Harjot]You know, I don’t think anyone would go into all Well, I hope no one would go into this kind of course, without having really thought about it very carefully. And I had to do loads of planning beforehand, I spent probably about 18 months planning finances and how am I going to pay for everything. And there were lots of things that I had to take into consideration, financially. Loss of earnings was one of the main things but I’m going to come on to loss of earnings in a second actually. But yeah, you know, the fee structure changes every year. There’s it always increases slightly every year. So you need to be able to set aside enough money to pay your tuition fees. In terms of loss of earnings, here’s the strange thing actually is although I’ve gone from being in practice full time to now, three days a week on in practice, let me see Mondays, Thursdays Saturdays. I’ll probably say even though I’ve cut out two week days, I don’t think I’ve ever seen the loss of earnings damage. And I’ll tell you why. It’s because you become more confident in what you’re doing. Your prescribing pattern also changes. So yes, there’s a loss of earnings, but I don’t think it’s as substantial. If you’re a full time student, then yes, that’s something you need to take into consideration. You could plan bit more carefully and put some money away. There are grants available [Jaz]Student loans, is that I mean, excuse my ignorance, but for postgraduate programs, speciality programs, is there a sort of student loan program? [Harjot]Take it up professional, they take out loans with the banks, they take out professional loans and then student loans. We’ve all been through the student loans company and some of us are still trying to pay that off. [Jaz]Yep. Guilty. [Harjot]Yeah, same here. They don’t give you any more money, unfortunately, for your post grad training, [Jaz]but it’s good to mention about you know, even though you cut down some days, your earnings doesn’t take as you know, as proportional overhead basically. And because you’re already reaping the rewards of increased knowledge and soil, working like a prosthodontist thinking like a prosthodontist. [Jaz]This is Catherine Tannahill, who told me one of her professional regrets, if you like is not specializing as an orthodontist. So for her to be pursuing a diploma in orthodontics is perhaps the next best thing [Catherine]I love learning is the first reason. And I’ve been doing gathered enough to orthodontic knowledge over the last few years, and more experience. And the more I know, the more I realize, I don’t know. And I want to be able to tackle more complex cases and refer less out to the practice [Jaz]Lourens is a successful private practice owner and he’s also doing the diploma with me. And he had this to say, [Lourens]Think from I don’t know, but you and me, Catherine, but I think we’re a little bit older. And so to go back to uni now, it would be hard to come and go reducing waste. I think. If I was born more your age. Yeah, I would consider it [Jaz]The main thing, but do you think you’d have to be a specialist to be successful to have fulfillment and Catherine talks about that or to do great work? [Catherine]No, definitely not. I think there’s such an orthodontic need out there. I think all people want at the moment, the current trend is straight white teeth, and people are asking for orthodontics more and more. So the demand is there. The need is there. I don’t think there are enough orthodontist, [Lourens]Especially with the NHS, considering orthodontics more of a cosmetic treatment now. That is definitely increasing the need and also with the kids not wearing their retainers. And then the majority of the desired treaters or relapse caps from NHS ortho. [Jaz]What’s the point? Why specialize? Why did you specialize? [Harjot]I never really thought about it. When I qualified I remember being a DF1. And the point at which I thought I need to not necessarily specialize but do something extra. And I remember it was quite vivid, really. I was sitting in the keynote lecture. At the BDA conference in Manchester, all the DF1s have to go on it. And Basil was wrong. He was talking. And I remember thinking to myself, right, how do I get to doing that kind of work? What kind of Route wanting to take and specializing and doing kind of structured learning and kind of formal pathway was something I didn’t even think about even at that time. It was only when I’ve been on a few courses, and I even did, Basil’s course, and I thought it was absolutely amazing. And I talked to a lot of people who had done similar courses, that I realized, actually, if I want to be doing a certain type of work and more dentistry that I like to do, where I could be a bit picky about the cases I wanted to do, then for me, I wanted to be able to do have enough depth of knowledge to be able to do that kind of work. There were some very influential people who really gave me a bit of impetus when I saw some of their work really, into thinking actually, specialist training is what I need to do, to do the kind of cases they were doing. [Jaz]Okay, can I just give you a counter argument? Are you ready for this? Yeah, I knew you’d mentioned Basil, was an absolute amazing clinician you know, his works, just Wow, you know. What about the Chris Orr’s? What about the [ ? ] ? They’re just BDS. [Harjot]Yeah, absolutely. And equally, I think that if you want to go down that route, that’s absolutely fine. But absolutely, there are loads of different ways to be able to get Your destination and achieve the goals that you want to do without having to do this kind of really expensive formal training, dedicate for three or four years. There are ways to do it. But I do feel that sometimes there are so many different courses out there. That said, there’s a reason why Well, for me anyway, there’s a reason why the formal courses that have gone through academic institutions have been there for you know, 40, 50 years is because they work. You know what I mean? And you always want to be, you want your learning to be deep learning, you also want it to have come from some kind of scientific grounding. And I think we’re all trying to implement kind of evidence based dentistry, but you really need to be able to scrutinize what you’re learning and where this evidence has come from. I think if you are part of an institution, you’re always going to be getting the latest knowledge. [Jaz]I agree or disagree. So I agree that I’m hoping that the institution’s we take teaching them the latest knowledge, but in your, tell me, in your clinics in Eastman are using and not in private practice in Eastman, are you using intraoral scanners, ie able to utilize the latest technology in that respect? [Harjot]This is the thing right? When we talk about things like intraoral scanners, and so we have got intraoral scanners at Eastman. We don’t use them in clinic, we have been trained to use them or use them in private practice, like you said, but we need to come away from our things, just gadgets, and we’re happy to play with really expensive gadgets, or are they really going to improve our clinical or clinical proficiency? Are we are we going to be doing better work? Are we actually doing better work? These are the things that we need to be able to scrutinize. We all like playing with, you know, new lasers and intraoral scanners and whatever the latest gadget is, but really to be able to say, is this really an important tool that I cannot live without? What does the evidence suggest? [Jaz]I think, you know, you need to learn it, you need to learn how to do you know, PVS full arch impressions in program you know, I think any dentist would need to learn that before they and then I think digital becomes a piece of cake. It’s more about the knowledge and implementation, occlusal design, lab technician communication. So yeah, I mean, I agree with you there. I mean, I think they although you might not have the most up to date cutting edge just because the scale of hospitals, but at least you’re learning, you know, timeless principles, which it would you say that’s alright? [Harjot]I think if you understand, if you have a really good solid foundation, then actually learning extra techniques on the side is going to be easier for you to do. [Jaz]And you can scrutinize them because you get knowledge, you get critical reasoning, evaluating everything, not just at face value, but actually, you know, the evidence behind stuff, which is a core component of obviously having a post [Harjot]Absolutely. And that’s what you want to do, right? Look we live in an age where social media is at the forefront of everyone’s lives almost. And every time you go on Instagram or Facebook, there’s always going to be someone posting something and you think to yourself, Well, actually, that looks really good. But actually, I wonder how that’s going to look in five years time, 10 years time. It’s easy to get carried away, but you really want to be able to scrutinize what they’re doing and say, Well, how good is that really, on a practical level? I wonder what it’s going to look like in the future? [Jaz]Well, the key word there is a predictability. Right? And with that, I was just, you know, thinking while you were, I was jotting things down as you we’re speaking about the specialist route versus being the best you can be with private courses and you know, being to level up, let’s say, to do [Manku and Crystal], which is you know, superhuman level if you like, but here’s my theory, okay? If you do it alone, and you do it via courses, okay, the chance of you becoming to the, you know, the level and knowledge and skill of these, you know, non specialist clinicians, maybe I don’t know, I’m gonna pluck a number one and 50. I don’t know, I just made it up. Okay. Whereas perhaps, through a specialist program, a top postgraduate clinical program, you know, it might be one in two, because I think we can both agree that not all specialists are born equal. And just because you become a prosthodontist, doesn’t mean you’re actually shit hot. I [Harjot]Absolutely. I completely agree with that. I think everyone is have different abilities, no doubt about it. Okay. And you can get better than that, you know, you can practice things, but there’s no doubt that even people with the same title, same degree, they’ve got to be of different abilities. [Jaz]Do you do or what do you think of that theory that, you know, maybe by going it alone, you might not make it to where you want to be. Whereas when you get mentored in a postgraduate program, it might be more predictable in terms of you being able to do the kind of work you want to be able to do? [Harjot]But there’s almost going to be an endless amount of courses that you can keep going on, right? I think for me, as a young clinician, I really wanted to be able to have constant exposure for a good couple of years where I could really see my skills improving, getting better. And I think formal training and something very structured was just completely the correct decision for myself. And like you said, why there are so many different courses out there that you can achieve a goal that you want you can be these, you can be really amazing at the end of it, but you’re gonna have to go on quite a lot of them, there’s not gonna be one course that gives you that. But then you can do what you’ve done as well, because I’ve seen you know, you pick good courses to go on, you go to Dubai, you’ve been abroad, you do them here in the UK as well. And you’re picking really good people to go and learn from that’s also really important. Like, we’ve gotten to the stage now where it seems like everyone is opening up and everyone’s doing a course. But be really, really careful in learning from because you want to surround yourself with the right people, a lot of these people are really good as well don’t get me wrong, but you’ve we’ve got courses and everything these days that actually, the key thing is, is to be flexible, and not be dogmatic in your approach. But the only way to be able to do that is to have relevant knowledge, but also have relevant experience. And I felt like having some hospital experience and actually treating complex cases in a hospital setting, whilst learning on the side was [Jaz]gives you protected time. Yeah, it gives you a really, really protected environment, where every step, just like dental school, I suppose gets checked over. So you know, that’s a real bonus of epi. Now, one thing I like about being a GDP, if that a funny patient comes along, and you know, you just you’re not gonna, you know, some patients, their values and your values are so different. Or you find that it’s a particularly tricky root canal, I really don’t want to be a loss of earnings, right attempting this one, or I might mess it up that but also, you know, I can cherry pick my cases, like you know what, there’s a great specialist down the road, he’s in charge of vancil, he’ll treat you even though your mouth opening is 25 millimeters only, he’ll do your full mouth rehab. So there’s always that great thing about anyone listening here, you know, who’s thinking that gdps can’t do great work, it definitely can. And if a mentored, a postgraduate program for you is for you, then hydroids got some, you know, great points there for you to consider. But GDP is always have cherry picking ability that they can always say, you know what, I’m going to send you off to the specialist. [Harjot]I think a lot of what I’m learning now is and by I’m nowhere near the kind of finished article, but I do find that I seem to be getting some cases, especially internal referrals now. And it’s usually a lot of the times it’s not just tricky cases, tricky people as well. [Jaz]Yes. Because I almost didn’t want to ask you this, but like, do you find people fobbed off people to the specialist or the the hospital environment? Because that’s an easy thing to do, maybe? [Harjot]So you know what, I think it’s becoming a lot more. I think it’s becoming more difficult to do that, especially in hospital. Because at the end of the day, if it’s a difficult person? Well, look, we have difficult people in practice anyway. Okay. And sometimes, especially if you’re in the NHS, you have to treat them, that’s just the way it goes. Right? In the hospital setting, they have a really strict criteria, you know, and if it’s a difficult case, find a difficult case, if it’s a difficult person, we can’t even think about that, you know, they sometimes they have to be seen wherever it is whether it’s in primary care, secondary care, we do get I do find that sometimes you end up getting some people who’ve just because people don’t want to treat them. But I mean, that comes with you got to understand why is that person being difficult? Is it as a person, it sure wasn’t because they actually have some real problems. And you’re going to be that person that’s going to some form of [Jaz]I think you could be a real you can give them hope, obviously. But I remember when I was a DCT at guys hospital, the manner I’ve been working on consultant clinics, the amount of specialist referrals we’d get for really basic stuff, but there was other issues, let’s call it in the patient, and they were just being I thought they’re being fobbed off [Harjot]There was some specialties that are really good. And for just getting on referrals, endodontics, perio, for example, right? You’re always going to have a referral base, people are going to keep referring to you prosthodontics is a lot more difficult to achieve referrals for because most gdps do that and prosthodontic work, right, everyone does their own crowns, bridges, implants, whatever it is. So really, like I said, it’s not just about wanting to become a specialist, it’s just wanting to have a better understanding. So you can do the kind of work that you want to do the level of work that you want to do. And a key thing that I really like is I remember Basil once said in one of his courses when I first went on it was you want to try and do more dentistry on less people some more comprehensive cases, rather than new bits of dentistry. And if that’s the philosophy that works for you, then find that will work for everyone. But this is not a, it’s not a recipe right? Not everyone has to do this. And you’re quite right. You can be an amazing GDP just by going on courses alone. And actually, some of the people I really look up to, they haven’t gone through any kind of formal specialist training and they are incredible clinicians. [Jaz]Absolutely. Well, why don’t we say a few words about if you’re a young dentist and or a student or you’re a seasoned practitioner and you Considering specializing How’d you find which speciality is right for you and I’ll share with you what piece of advice actually you know Reena Wadia? Periodontist Okay? We did this like a talk, it was me telling Reena we was giving a lecture at King’s dental society when the lectures and evening and she said something really great that really resonated with me. Okay. And the question the audience was, how do I know what do I specialize in or you know, which was that along the lines, which is a common thing, you know, people not sure I wish I do endodontics a bit maybe they decided in a practice or one specialized but I’m not sure what in and Reena said something along the lines of and she said it more gracefully of something along the lines of you will gravitate towards it, you will open up these magazines, and journals, and you’ll find that you’re tending towards a particular thing over time, and you just, you know, naturally gravitate towards it. But for me, it was, you know, occlusion, splints, bigger cases over time, moving away from single tooth dentistry. And you know, more and more, I’m picking those up and reading more about that how to do this, how to use a in a few years goes about leaf gauges, how to use a leaf gauge, how to manipulate patient in centric relation, you sort of you find your way, in terms of your interests sort of lead you there. What do you think about that? [Harjot]Agreed. I completely agree, I also think this will happen according to what your experiences are, right? If you have found it difficult to take teeth out, you’re not going to really like all surgery, and you’re probably going to rule it out from day one. If you’ve had a hard time doing molar endodontics, I don’t think endo is going to really be the one for you. But sometimes it can be the flip sometimes by not being so good at something and then saying, Well, actually, I need to go on a short CBD course for this. And then doing some short endo course, for example, you might be like, I actually, I really enjoy this, I want to take this further, I was never really good at this. Now I really enjoy it because I understand it a lot better. And I’m going to try and pursue this a bit more. [Jaz]I’ve definitely seen that I’ve got some people in the back of my mind right now who went through that exact pathway, actually, they they weren’t doing much of anything or referring it out. And then they started to dabble in it. And they thought, you know what, that’s pretty cool. I’ve enjoyed my journey, and learning. And then they’ve gone the full whack and they’re doing specialist programs now [Harjot]The thing, the way to do it, though, is always to do a short course first. And I was really glad that I did Basil’s course, I now just finished VT and I’ve just done it, because it opened my eyes up as to where I was, and where I kind of wanted to be at some point in the future. And you don’t like I said, it was only through taking recommendations from people as to how they got there, which was specializing in formal training. And that was just something that worked for me. But I think do short course first do taster sessions a lot of these big institutions, Kings and the Eastman they do one day courses, ewisdom that was a good stuff on [Jaz]The thing I like Harjot is shadowing people and you know, yeah, you can shadow specialist, but you know, I’ve shadowed some brilliant gdps. And that sort of cemented my current standing that you know, I really enjoy general practice. But it was you know, being in that environment, watching their daily practice, and then able to inspire me. So definitely go out there. And if you’re thinking about prosthodontics, see if you can arrange a shadowing session in the West End, for example, with a prosthodontist and see their workflow. [Harjot]And you’re right. And it’s when you when you shadow people, and they’re giving you little these kind of golden nuggets of information that seem so valuable. You always remember them. And then you always wonder, where did you learn that from? And it’s usually because someone else has told them that when they shadowed them, you know, and I think you’re quite right. Finding the right people to shadow is important. It’s not an easy thing to do. And sometimes you do have to pester people, do what I did, I unlike what you did, as well, you know, going in on the weekends and assisting for free and taking photographs and just helping them out in whichever way you can. But you’ve got to do the legwork, right, you’ve got to put the hours in and you’ve got to be prepared to go in after work and maybe on the weekends to just kind of hang around and find how these people crystallize the treatment planning and how they got their thought process. So clear and concise. [Jaz]Absolutely. When you see all these photos on social media of these cases, or if you go on, let’s say right, that’s a restorative employment practice excellence group on Facebook. When you go on there, and you see the photos, what you’re seeing is an event like what you’re seeing is [Harjot]Yeah, absolutely. [Jaz]You don’t see the process that led to the event, you don’t see the blood, sweat and tears of hundreds of hours, the courses, the planning,I feel, yes, you do sometimes see the failures on this group, which is why I love these groups who show their full protocols. But you don’t see the 10 other cases beforehand where the dentist was not quite 100% happy with eternally every element of it and only when they got a case, which had a few more acceptable compromises where they’re happy to share it on social media, so You know, you don’t see the the hard work and the process that goes into it, you just see the event. So it’s always important to remember, there’s always going to be hard work, blood, sweat, and tears involved, no matter which path you’re going to go down, if you want to be at that caliber of clinician, [Harjot]Often the most important thing, or the thing that’s most valuable from looking at, like you said, photographs, or a treatment that someone’s done. And all you have is information, visual information, or maybe a caption, I found the most important thing is that should be able to talk some of these people really, really pick their brains as to what made you want to do it this way, and not that way. Because sometimes they don’t give you the alternative treatment options and why they specifically chose this, you know. So I’ve always found that really, really, really quite helpful, really being able to talk these people directly and say, Why have you done this? And also reflecting back on yourself and saying, Well, why haven’t I thought of that? Is it because I just don’t have the knowledge about it. I haven’t been locally relevant experience. And being able to learn from it really, you know, [Jaz]Now we can listen to some of my colleagues who are doing a diploma in orthodontics. This is Kiran Juj. [Kiran]The thought of having to go back to hospital and doing an act a job where I’m literally doing it to jump through a hoop. And I’m not really finding that I’m gaining any experience in the future I want to do and something I’m doing some I don’t really enjoy does put me off. [Jaz]Let’s hear Sunny Luthra’s input. [Sunny]If you want to just do regular routine, general dentist, that’s fine. There’s no issue with that. But I don’t think you necessarily have to be on the specialist list or be a specialist to do good quality dentistry really, good practice makes permanent. No one knows that actually mean. You could be doing it wrong and still be really good at doing it. You don’t want to be doing that, because you need to know how to do it properly. Now, there are many ways to do that. That’s for the individual to find out. But what I am saying is once you learn how to do it properly, get in there and do it properly. Don’t cut corners just because you’re getting a low fee on the NHS or you’re not getting any money or your principal or whoever saying referred about, No. Get in there and learn how to do things the right way. Jaz’s Outro: So hope I managed to get into the nitty gritty of it all in terms of the true cost of specializing taking into account the loss of earnings, but also putting out there that some of the best clinicians I know are not specialists. However, as you heard from Harjot and his passion that you know, sometimes specialists really, really, really can make a massive difference in terms of how rewarding that can be when you limit your practice to something. So you know there’s no right or wrong answer. You got to live the career that you want to do it. You got to make it where you want to be and specializing is just one way of doing. So. catch you in the next one. Thanks for listening.

Episode 5 is an interview with Dr Robert Conville (@robconville) who shares his experiences of working in Australia with a BDS degree from the UK. Need to Read it? Check out the Full Episode Transcript below! This episode’s protrusive dental pearl is about how to get perfect moisture control for those difficult class V restorations. This episode covers: Visas and the recent change in codes Sponsorship AHPRA Finding an Employer How to look for a job Do you need a Chest X ray? Entrance exams? How do the dental care system and health funds work out there? What is the remuneration and earning like as a Dentist in Australia? Applying for permanent residency Experiences in Australia Work, Travel and Living in Australia Dentistry.co.uk article written by Rob Click below for full episode transcript: Opening Snippet: Welcome to the Protrusive Dental podcast the forward thinking podcast for dental professionals. Join us as we discuss hot topics in dentistry, clinical tips, continuing education and adding value to your life and career with your host, Jaz Gulati... Jaz’s Introduction: Hello everyone and welcome to episode five of the Protrusive Dental podcast. As promised, this one is about Australia. It’s for dentists who are looking to move to Australia, which for so many years has been such a popular destination or place for dentists to consider going to. Many Dentists have moved there and settled there. While some have actually gone there had a great experience, make great memories and come back to raise their families back in the UK or wherever they are in the world. I’m joined today by my good friend Robert Conville and similarly to the one where I was joined by Surinder Aurora for Expat Dentist in Singapore that was episode number one. This one’s about giving you advice and tips if you’re considering moving to Australia for dentistry, or if you’re already there, how to look out for job opportunities, how it works with other people, spouses, visas, all that sort of stuff. Before I get to that though, today’s Protrusive Dental pearl is a trick to get excellent isolation for class five restorations. Class fives are typically on dentine or root dentin and therefore suffer with less predictable bond strengths to resin composite. Isolations always trickier. I’m a huge fan of using rubber dam for all if not most of my composite were appropriate. But sometimes, if rubber dam isolation actually makes your restorative dentistry more difficult then I’m against using it. So even if you have a class five cavity, and you’re using rubberdam. And even if you use your Brinker B4 clamps to really get maximum retraction, then those who use rubberdam on a daily basis will still know that there’s a degree of seepage that happens around the rubber dam. So what do you do then? Well, the tip I picked up from Pasquale Venuti in Sydney, is to use ptfe tape packed into the sulcus. Now, depending on the biotype you’re dealing with, you can use it rolled up like a retraction cord, or you can use it like a napkin almost and just pack it inside the sulcus. Don’t take my word for it, try it, the cavity will be bone dry and even inspected in a microscope, you’ll find that there’ll be no moisture seepage at all. So I mean, I know there are a myriad of uses of ptfe tape, and that could probably fill a hole shown itself. But this one is one of my favorites. So let’s now join Rob and talk about Australia. Main Interview: [Jaz]And so Rob, just tell us a little about yourself to the listeners, who are you know, where do you qualify? What you’ve been up to? [Rob]Yeah, awesome. So my name is Rob. I was in the same university as Jaz. I was the Apollo Jazz at University of Sheffield and I graduated in 2014. So that was a great time. I following that I completed my vocational training in the Wakefield scheme near Leeds. I still lived in Sheffield. And after that, I continued on to my dental school training year maxillofacial surgery in Sheffield. And then that’s when I decided to make the move to Australia. So yeah, I was there for two years. And I’ve just returned in the July 2018. And I’m now back in Sheffield working in the pediatric department. [Jaz]So tell us why Australia? [Rob]So for me, Australia, I went to Australia, my dental active in the fourth year of university with my friend Tom, and we had a really great time. And we kind of we traveled through Australia, I thought what a great place to live. And I just thought, you know, when I graduated from university, I really wanted to experience working abroad. And so yeah, Australia for me was it was always kind of a plan. And yeah, [Jaz]Did you not consider anywhere else? [Rob]Yeah, we looked. So I looked at America, and I looked at Canada. And there are a few other places. I know you went to Singapore, yourself, Jaz. But so in some of those areas, you know those places you need to sit exams and Australia seemed like a good place to go, they recognise English qualifications. So yeah, that was my main choice. [Jaz]Okay, so you decided want to go to Australia? What are the first steps that you took? And would you do anything differently now compared to what you did then? [Rob]Yes. So I think the first point of call was I tried to speak to people who’ve been before. So there’s quite a few. There’s loads of English doctors and dentists who’ve moved over to Australia. So I kind of got in touch with people I knew who had been or still there just to get their feel and what it takes to kind of get the application sorted. So that was kind of in my dental school training year, I was speaking to friends who are working in Perth. And they were like, Yeah, you’ve got to come over. You’ve got them. It was really positive. Everything they were saying. So yeah, it’s looked into the process of visas and it does take quite a long time. It does take a long time. [Jaz]So you would apply for the visa while you’re in the UK or how’s it work? [Rob]Exactly. So you’ve got a few options really so I, you can be sponsored. So I started Googling like dental companies and there’s companies in Perth like DB dental, and who’ve got strong links with the UK and getting UK graduates can work over there. So I suppose some friends who work there so and then I looked at other corporate dental companies who sponsor UK dentists, and there’s a few routes, you can go about it, you can either do it yourself and you can apply for a job. But [Jaz]Is that what you did? [Rob]Yeah, so I initially applied for that route. [Jaz]So if you’re going to be doing it yourself, tell us your route. And then we can discuss the pros and cons of doing yourself. So tell us how you did it. [Rob]So I actually organized I got a like a backpacker visa, which is like a one year kind of visa, which allows you to go work in Australia, however, there’s limits on that visa. So you can only work for six months at a time with one company. And then you’d have to change. So I went on a kind of a one year visa. And I successfully got a job interview with one of the dental corporates who said that I could go and work for them. And they considered sponsoring me, [Jaz]But they were in on it, right? They knew that they could only take you on for six months. Right? [Rob]Exactly. So they kind of knew that after the six months, then I’d have to either be sponsored by them, or I’d have to kind of change, you know, my employer. So I actually worked out because I was moving over there with my partner who’s a doctor, we managed to join our patients together. So Faye was actually sponsored by her hospital. And then I managed to be sponsored by the hospital also as like a de facto partner. So then I was able to continue to work for my dental company for the two years that we were there. So it’s great. [Jaz]Okay, so that’s one way of doing if your partner’s going to get sponsored. What if you’re out there and you’re not fortunate enough to be in a position where you know, you’ve got someone in the medical field who’s gonna get sponsored? Imagine you just work for a company six months, on this backpack a visa, as you say, either the company has to then sponsor you. Or you know, your stuff, right? [Rob]Well, yeah. So your options are you either would have to then change to a different company for six months. Or you then could go and travel and do you know, explore the country if you wanted to. And Yeah, you’d have to take a sponsorship with that company, and then they would sponsor you for a time period. And you’d have to honor that with them. And they can offer you you know, certain amounts of time, I know that the standard time was two to four years, that’s generally what they were, they offer people in the contracts, but [Jaz]What’s in it for them? And what’s in it for you? If someone sponsored you? [Rob]Well, to be honest, the application itself cost quite a lot. So I think for one of the visas that you know, looking at, anywhere between $1,000, up to maybe $3,000 for the visa, [Jaz]And this is you paying or your sponsor paying? [Rob]So the sponsor would pay for your visa, so you would have no fees for the actual visa itself, because they’d be paying for it. But then you’d be tied in with the contract on a salary. And they’d discuss terms and conditions with you that discuss commission rates, etc. But you’d then be an employee of that company, and they’d have a bit more kind of control over kind of your working hours, etc, etc. So, [Jaz]So in this case, you’re not like a normal, self employed associate taking a percentage, or is that element of that in there? [Rob]Well, there definitely will be a little element, but you’ll be classed as an employee. So you’ll be given a base salary. And then on top of that, you’ll have your commission which will come in. Whereas if you are self employed dentist, you’re paid primarily on commission just on commission. So there’s no salary aspect to when you’re self employed dentist. [Jaz]Okay. And do you have to get a I mean, is sponsorship a mandatory requirement? For foreign grads? [Rob]Yeah. So for foreign graduates, if you’ve not got a partner who’s sponsored by different company, and then you can like piggyback on as a de facto, then, yeah, the only way that you can go and work there is by sponsorship. So you do need to take up sponsorship to get the visa to go and work as a dentist so [Jaz]And then how long do you need to then stick up with that before you can just be any old Australian dentist who can work anywhere when they want, you know what criteria do to fulfill? [Rob]So then most people who come and go over on a sponsorship visa will be given say two to four years on that sponsored visa. After that, then you’d be in discussion talks with your employer to sponsor you to go to apply for permanent residency, that’s generally the route that people take. Now, the visa systems are all changing at the moment. So when I first moved across the sponsored visa was called the 457. Now that was their permanent, that was the sponsored visa for skilled workers. Now in March 2018, so when we were just leaving, they decided to stop that 457 visa and they’ve changed it and now I had to have a read up on this because I myself wasn’t on the new visa, but it’s called the 482. It’s very similar is to say, allows you to work full time with an employer in the nominated position as a dentist, then, you know, they’re generally for short term kind of stays. So generally two years. Now after that two years, they can extend it to four years, I believe, but on the four year visa that’s when it after that rough period runs out, then that’s when you’d have to move towards permanent residency. Now with the way the visa going, I’m not sure the route to permanent residency through this new visa system because I wasn’t on it. So. [Jaz]Okay, so really, you know, if you’re going out there as dentists, the ADC, is that what they call the Australian dental study? It’s not really them who are limiting you from working, it’s more the immigration side of things. [Rob]Definitely there is that the visa aspects and the immigration aspects. There’s Australian dental council who you don’t have to actually register with. You register with AHPRA, the Australian Health Practices Regulations Authority. Now, they’re the ones who register all the practitioners, so shrub lists, you know, dentists, doctors, all the health care professionals or registered with AHPRA. So you only need your AHPRA registration. And you don’t have to be a member of the ADC. Now, if you stay there longer term, I think there would be a push to for you to go and be a member of the ADC and sit the exams. But no, [Jaz]but it’s not a requirement? [Rob]It’s not an essential requirements go work there. But you do need AHPRA registration that is the one that you need. [Jaz]Okay, and AHPRA registration? Does it cost money? Does it take long? And are there any criteria or exams that you need to fulfill? [Rob]Yeah, definitely. So AHPRA registration, it’s a bit like the GDC for us, it’s similar or equivalent, it was off the top of my head, I think it’s between $600-$700. So it’s less than, you know, the GDC fee of 890 pounds. And timewise, again, when you apply for your first time, because you apply before you move to Australia for the AHPRA so that when you get there, you can start working, it does take a long time. So I think I started looking in the march time of 2016, for working in September, and it came through like the month before I got there so it can take [Jaz]So five months [Rob]Y can take you know, I gave myself six months to be able to everything out because not only your AHPRA registration, you need to do police checks, you need to do health screenings, it needs to have a chest X ray, because you’re going to be working as a dentist, you need to obviously apply for your visa through the immigration system. And then you’ve got to apply for your AHPRA, which is the medical licensing board. [Jaz]Okay, and but you don’t need to pass any exams? [Rob]There’s no exams or anything like that. So that perfect. [Jaz]Yeah. That’s much better. So the first thing you need to do then is register to AHPRA? Or is the first thing to do to find a sponsor? Which of those two do or is the first thing the visa changes to 123? In the order of how you’d actually [Rob]So order I would be would be just contact, you know, contact one of the employers over there, whether that be someone who, like a corporate dental company, or go on to the ADA website, the Australian Dental Association, and there’s loads of job advertisements and vacancies there. And I just sent out loads of emails to people saying, you know, I’m English dentist wants to be across, and you probably will, when I first started, I didn’t get much replies at all. Yeah, I sent out loads of emails. But then I did get one. And that was from one of the corporates, and they were like, Oh, this is what you have to do. So yeah, first of all, talk to an employer. Second point would then be the visa application. And then third, and finally would be the AHPRA registration once you’ve got the job kind of secured with the visa. And then with the AHPRA, that’s the route. [Jaz]Sure. But you but you need the job. You need the sponsor to then help the visa. Right? [Rob]Yes, exactly. So the first point of call is speaking to an employer or potential employer. [Jaz]Yeah. Okay, fine. And what are the opportunities like there? Are they hungry for UK dentist at moment? Or is it a bit saturated? [Rob]I would say they definitely are, I had a great experience. And I know everyone who is over there, and who are English dentist sound a great time who are still there. But there’s definitely a saturation of dentists in the bigger cities. So I was based in Brisbane, and a great place if anyone’s interested to go and visit Australia. But then there’s a lot of dentists there in the cities and the rural areas is less kind of dentists. So there’s probably more a higher need for a dentist there, however, and jobs are competitive wherever you go. But you’ve just kind of got to go and just, you know, make sure you see these up to scratch. And, I find it quite difficult to get a job. But at the same time, it’s easy when you’re there. You know, when you’re working on Skype and emails, it’s quite hard to meet potential employers, it’s difficult, but you’ve got to just persevere with it. And I’d say it’s definitely worth it. [Jaz]Brilliant. So once you’ve got your job lined up by someone agreed to sponsor you, then they help you with the visa and the AHPRA and everything takes about five to six months. You start working as a dentist in Australia. What’s it like there? How is it different to what you experienced in the UK? [Rob]Yeah, so it’s all private in Australia. So coming from my VT kind of experience in like a mix NHS private party. Yes, it was very different, the way they pay for the treatment. So quite a few patients will be on like a health funds or have some sort of health insurance, which covers them for a range of dental treatments. And they kind of have, they have rebates on treatment. So, safety doing a checkup, and they’re on a Health Fund. And the Health Fund will cover the checkup, they don’t have to pay anything out of pocket. But then you have people who don’t have any sort of insurance at all, who then just have to pay for the treatment, like a fee per item sort of thing. [Jaz]Okay, is insurance something that you take out as a policy? Or is insurance something that people get if their income is below a certain level? How does that work? [Rob]Yeah, so generally, people take it as policies as this, there’s booper, there’s medibank, private, there’s an Australian Defence Force, there’s loads of different sorts of insurances. So they generally take ours yearly policies, and the dental will be one aspect of that wider Health Cover. So as a dental practitioner over there, depending of who you work for, you’ll be kind of a preferred, what we call a preferred provider for one of the health funds, or if you like, so in one of my clinics where I worked, we kind of covered the majority of health funds. So that meant, we’re, you know, most patients who had a health and could come and see us for treatment, and they get the maximum benefit. Whereas if you weren’t a preferred provider for that health, and then the patient might not get the maximum benefit back. Does that make sense? [Jaz]Yeah, I’m with you. So is it some clinics may not be able to accept all the different policies out there? [Rob]Yeah. But obviously, they can still provide the dentistry but you know, the patient would want to get the most back for their health Insurance. So yeah, it was excellent. And so you know, it’s private practice where I worked. I worked for a corporate and for a family practice as well, I was working. Towards the end, I was working 6 days a week, every four nights. So I was really busy. I wanted to get the best experience over there as possible. And yeah, just a really, really fresh kind of Outlook to Dentistry of that actually [Jaz]Good. And how many patients were you seeing roughly? Is it bit like, you know, was it overly busy? Or was a bit quiet? [Rob]Well, it kind of all depends on you as a person. And generally, I didn’t see more than 20 patients in a day. And that was kind of, you know, that’s just the way it went, it depends how busy the clinic is, obviously, and where you’re based. But yeah, you can kind of choose how long you want for your patients. And obviously, because you know, patients are, you know, you I want to spend as much time with the patient as possible, and I wanted to deliver the best care, and I want to do my best. So I booked out longer appointments that if I felt it was needed. So yeah, it wasn’t a stressful environment at all. [Jaz]Cool. And, you know, the most common question people get out there is how much could you expect to earn? And you could probably answer that in a couple of ways you can answer that, from someone who may be on a sort of sponsored contract, and what the average GDP in Australia could be looking to earn. Can you give us an average figures? [Rob]Yeah, so I think on the salary side, when you’re, if you’re say employed there, you know, they say a yearly salary would be roughly around $85,000, which is really, really good at the exchange rate, I’m not sure what that is at the moment. But then obviously, on top of that, you can add your commission so and [Jaz]That’s pretty much guaranteed that [Rob]That’s like a base salary. And then on top of it, you know, you can add to commission, depending on how many patients you see or treat in a month. So that gives you an idea of roughly, like an average, [Jaz]Have you gone average for, you know, permanent resident Australian dentists who are not on a sort of contract? Or is that something you’re not sure about? [Rob]Yeah, yeah. So I think I think you could range really, you know, if you’re working in a busy clinic, you know, five, six days a week, you could be looking at, you know, $150,000+ if you know, for an experienced data processor with a stable list, and you’re well established there, but, you know, y’all know Jaz, you move to Singapore, once you arrive, you know, you have to build patient, you know, build a list, build rapport with patients, and it does take time as it does here. [Jaz]Yeah, I mean, in Singapore, as I talked about, the first episode was, you know, it depends a lot about demographics, where you are practicing as well. And these are things that apply anywhere in the world, I suppose. [Rob]Yeah, you’re definitely and I found, I worked in the city of Brisbane, I also worked in like a rural kind of suburb of Brisbane. And there are obviously differences there. But you know, I think the experience, you know, you go for the experience, and it was a for anyone interested in moving to Australia, I can’t recommend it enough. [Jaz]And I mean, obviously, you’ve back it, but for those who are wishing to, you know, become a PR, do you know how long it would take for them to become a permanent resident? [Rob]Yeah. So you have to be there for at least two years. So you have to work there for at least two years, even to be considered for permanent residency. So if you were looking to go towards, move towards permanent residency, you’ve got to commit to at least working there for two years before even applying. So Yeah, that’s where you want to bear in mind. [Jaz]Fine. So once you’ve got your PR you can, you’re not really reliant on sponsorship anymore. You can really work in any city that’s or any practice that’s willing to take you on. [Rob]Exactly, yeah, you’re free, you’re free to go wherever you want. You’ll be self employed and test, you know, and after PR, that’s when people sometimes go apply for citizenship, which is, you know, you can probably a citizen of Australia. So yeah, there’s options afterwards as well. So, [Jaz]But you know, you wouldn’t start supporting Australian rugby or something stupid. That wasn’t you. [Rob]Yeah. True England fan of heart, Jaz. You know, me. [Jaz]I know. That was just a cruel test. Do you have any tips that you can give to people who are in your position? You know, thinking of taking the big step and moving, crossing a long, it’s a long way to go Australia? I suppose, you know, how can you help them get leverage out there? [Rob]Yeah, I think it’s really difficult. Because when I moved over there, I didn’t know anyone really, in Brisbane, didn’t really know the city very well, on my elective, we were only there for two days. So it was a massive kind of culture shock. And also, you’re away from family and friends. But you know, when you put yourself into these kind of uncharted waters, and you, kind of, it’s exciting, and it’s like an adventure. And to be honest, I wouldn’t change anything. It was the best decision I made. Hands down, you know, oh, you know, I had a great experience working maxfacts and everything, but going to Australia was the best move, you know, opens doors for you, because I was amazed to learn, you know, new things like digital dentistry, we’re seeing the was working, there was CEREC, there was TRIOS. We had intraoral scanners, we had our intraoral cameras, you know, on the units, it was just so well, you’re well supported over there. And it was well funded. So the equipment was excellent, you know, using sectional matrices, and just a really good experience. So for a newly qualified dentist, I would highly recommended and you know, this is such a big place. So there’s so many different you know, I know, I’ve got friends who work. [Jaz]I mean, I remember seeing all your photos travelling around Australia. [Rob]And that says, well, it’s not just work. You know, it’s the whole aspect of living overseas, being able to travel. You know, we’re, if you’re in Australia, you can go towards New Zealand, we went over there, and you can work there as well. I didn’t I never worked there. So you’d have to speak to someone else. But it’s an excellent place to visit. And just a really nice lifestyle, it’s very out if you like the outdoors, it’s a great place for you. [Jaz]Absolutely. And could you see yourself, you know, it could have gone a different way. And you could have become a PR there and live there forever. Is it, Could you have seen yourself do that? [Rob]Yeah, definitely. I think you know, and you probably speak to many people who who have been there for many, many years, they’ve moved over from the UK. And they’ve stayed there and settled with their families, and they’re having fantastic lives. And for me, personally, we’ve got like a really close family here. And even for us, if it’s the right time to be back. But I’ll never rule out me going back over there again. It was, we’ve made some excellent friends over there. And yeah, it could have gone one of two ways, but back and happy in Sheffield now in God’s country in Yorkshire. So [Jaz]that’s been really efficient and really useful. I think that’s going to help a lot of people who are thinking of moving out to Australia with their BDS. And I think you’ve given a good nicer insight into what to expect in dentistry, working conditions. Is there anything else you’d like to add at all? [Rob]Yeah, I was gonna say I when I first moved over the to Australia, I did write a small article in the dentistry.co.uk, it was in November 2017. And that’s kind of got the little points that we’ve kind of been through. So if anyone’s kind of, you know, wants to have a look at, you know, [Jaz]Send me the link, I’ll put it in the show notes. So yeah, we’ll click on the bottom, and then they’ll be able to see that’d be really useful, actually. [Rob]Definitely. And then yeah, thanks very much for your time. It’s been really, really good fun. [Jaz]Oh, thank you, Rob. It’s always a pleasure catching up with you. And I’m sure I’ll see you very soon, mate. [Rob]See you soon thanks, Jaz. Jaz’s Outro: Well, I hope Rob’s experiences and know how has helped you in some way. He’s a very helpful person and one of the nicest guys around in dentistry. So do reach out to him if you need any further information or help. He’s very supportive. Please stay tuned for the next episode, which is going to be absolutely huge. Can be the biggest one I’ve done yet. It’s got several people speaking on it, giving different perspectives, answering such a big question, that question that crosses everyone’s mind at some stage whether the beginning of the career or even the middle of the career is Should I Specialize? Should I pursue extra degrees? Should I do an MClindent in a certain subject. So we speak someone who is doing prostho, someone who’s done the conservative MSC at Eastman, people who do are doing orthodontic diplomas. I’ve got loads of people in the show giving different perspectives, GDPs as well. Team GDP. We’ll be talking about the pros and cons, financial aspects, anecdotes specialization. So it’s actually a really big one. I hope it’s gonna be really helpful to people early in their career or in the middle of career considering whether it’s worth specializing. So again, if you liked this episode, please do share it. Like the Protusive Dental podcast page on Facebook and register on www.jaz.dental if you want email notifications of new episodes and free content, which I’ll be putting out. Peace out.

I hope you enjoy my discussions with Dr Neel Jaiswal who founded the British Academy of Microscope Dentistry. Need to Read it? Check out the Full Episode Transcript below! This episode’s Protrusive Dental Pearls: Use Fiverr.com for purchasing logos, soundbites, artwork and creative services How to minimise occlusal adjustment of composite restorations and avoid ruining your beautiful anatomy! In this podcast we discuss: Which Loupes to buy for Students Benefits of Loupes vs Microscopes Features to look for in a Microscope purchase Communication gems and adding value to your Scope Photography and ergonomics with Scopes If you liked the sound of Mahul Patel’s PrepEvo course, find out more about how to make your preps awesome. Click below for full episode transcript: Opening Snippet: Welcome to the Protrusive Dental podcast the forward thinking podcast for dental professionals. Join us as we discuss hot topics in dentistry clinical tips, continuing education and adding value to your life and career with your host, Jaz Gulati... Jaz’s Introduction: Jaz, Why do you have this American dude doing introduction? That’s often a question I get. And the answer to why I have this American do doing is brilliant. Doesn’t sound really professional really good. I really like it myself. I’m blowing my own trumpet if you like for choosing this guy. Where did I find this American guy to do my podcast intro. So there’s amazing website called fiverr.com. That’s F-I-V-E- double R. There’s two Rs at the end. And the concept of this website when it initially began is for five US dollars or about at five pounds. You can get lots of different services. I’ve had logos made. I’ve had my introduction made for this podcast, you name it. There’s lots of artistic stuff out there. So check out fiverr.com and it’s not even been a minute wouldn’t this podcast and I’ve given your Protrusive Dental pearl number one there already. So it’s been a busy few weeks. For me I was in Dubai earlier this month on a course. The course was by a chap called Lukas Lassmann, Polish dentist, who basically teaches about full mouth rehabilitation concepts. He basically preaches the John Kois, the Kois school of thought, and I thought it’d be good to go to Dubai to get some sunshine, my wife as well, while attending this course. And that was really cool. I’m also doing the Dawson Academy from next month modules to be in May, so I’ll be sure to share my experiences with that. But last week, I was at Mahul Patel’s PrepEvo course. And that was amazing. We do a prep, let’s say for a full gold crown upper right six, and then it gets scanned in by you know, one of those prime scan, dentsply, [sironen] scanners, and instantly, it tells you how close your preparation is to the gold standard proper preparation, which they call the [Gold Particle]. And it was amazing to see instantly how good or otherwise your prep was. And then he teaches his protocol Mahul Patel. He teaches his protocol how to get better preps if you’d like and then we prep it again. And then we get scanned again. And instantly we see if we’ve gotten better or some people actually get worse because you know, it’s a new technique you’re learning, the average sort of score that a dentist gets out of 600 sort of preps that have been done possibly more is 18% Mahul told me. So 18% of the preparation is to within 0.1 millimeters of the Gold Particle. So I was quite shocke 24% first time around 40% in second time round, and I really benefited. I think my preps come Monday morning will always be better now from going in that course. So if we’re looking for a prep course, with someone who’s a great educator, I really recommend Mahul Patel’s PrepEvo course, do check that out. Today, of course, we have Neel Jaiswal, we’re talking about magnification, we’re talking about microscopes, loupes, all sorts, what I’ll do is I’ll just tell you which part of the podcast today sort of covers which topics. So the first 15 minutes or so is about the importance of magnification, and illumination. And if you’re looking to buy your first pair of loupes as a student perhaps, and the transition from loupes to microscope, the second third is about why buy a microscope? Is it affordable? Is it a return on investment? And something I share with you, which I think was quite funny, actually, is that diva mode, I created this find out what diva mode is okay, that’ll be in the second third of it. And the final third, it will be basically more specific microscope based advice about the what sort of lens cause you’re looking for. The advice on what to look for in a scope, should it have a fixed or reclinable head for example, secondhand scopes, because they are very affordable compared to let’s say a brand new scope, and how to get around the difficulties and photography during when you’re using a microscope. And it’s actually the whole point, the whole interview with Neel is littered with a really good communication gems, and Neel is a true gem as you’ll hear. The second Protrusive Dental pearl I want to give you today is when you’re doing your composites, let’s say you’re doing a posterior composite. I’m hoping everyone’s checking the occlusion so I check it with let’s say red aquatherm papers about 21 microns and I get them to buy together I take an intraoral camera photo of that and trying to replicate the marks later. But when you actually isolating your rubberdam and you’re trying to make the restoration, anatomically correct with good form, and with that will follow function. And often when you remove your rubberdam, check in occlusion a lot of time you’re beautiful and that moves being completely wiped away. So the tip I have for you to reduce the amount of adjustment that you need to do is let’s say you’re replacing a leaking carrier amalgam. You remove half the amalgam, okay, and you put your Williams probe inside and you measure the height of that amalgam and you know How much composite in you to fill there in sort of midsection. And then of course, you can add your cuspal inclines in. So the tip is to measure with a Williams probe once you’ve removed half the restoration, and that will give you a guide as to how much to build up your composite resin. So hope you’ve enjoyed that. And please enjoy this podcast. And I’ll see you after the interview just to summarize everything. Main Interview: [Jaz]Okay, Neel, Neel Jaiswal, thank you so much for joining me today on the Protrusive Dental podcast. Really, really happy to have you on. Please, can you let the folks listening today, You know, tell us about yourself. [Neel]Hi there Jaz and yeah, thanks again for inviting man sort of been qualified 20 odd years normal wet fingered practitioner. And I have my own private practice in Hertfordshire. [Jaz]It’s a beautiful practice I went to a few weeks ago, it was gorgeous. And we’ll talk about your microscope shortly. Because that’s what today is about. But yeah, lovely practice. If anyone ever is in that pod sound, you know, it really is a standout practice. [Neel]When your your guys or people do come along. And we do have little chats and try and help dentists especially young adults. So you’re definitely welcome. So yeah, have a lovely private practice with a fantastic team. And really kind of what set me on that journey was going to Spear in Arizona having gone there quite a few times. And plus my mentors in this country. And then really from there just having this drive to want to do better and better work and seeing all this stuff on Facebook thinking how on earth are they doing it? And through various journeys, which I’m sure we’ll talk about, we ended up really becoming a you know, my practice, but me being a Microscope centered practice. In fact, I don’t use loupes, as we were just talking about earlier. And so yeah, BAMD does being which is the British Academy of Microscopic Dentistry is I’ve been for a few years. And alongside that I’ve been helping Dhru with the study clubs in England for Dentinal Tubules. And quite involved in a little car group that I run on Facebook. [Jaz]Turbine group? [Neel]Turbine. Yeah, we [Jaz]Know about this. Will link in the show notes. And if you’re into cars, and you know, your dentist, and Turbine would be an awesome name, and is a great group for people to connect about cars. So Neel has lots of things and lots of surprise. But he you know, he’s very passionate about all these things. And he’s amazing at all of them. [Neel]Well, definitely. I mean, one thing I really like to do is bring people together, whether it’s through education, through study clubs, and with turbine oil. It sounds gauche that we’re talking about cars, but should we do lots of events in current climates, I think dentistry we need to get together and build together. And that led me on really to starting an indemnity company with my business partner, Gary. And we are now running professional dental indemnity, which has been from strength to strength. [Jaz]But by the way, I mean, I this show is not sponsored by anything or anyone that if you want to sponsor me now, get in contact. But this year is not sponsored. And but I am a PDI member myself, and I’m just gonna give a shameless plug, when you’re filling in the actual form, it really does stand out how it’s different to conventional indemnities. It’s insurance based, and you actually get to write down exactly how many sessions,what percentage of which treatments that you do, and they give you a really bespoke quote, as much lower than someone you know, the dental protection, the daily use of the world. And I’d really think what Neel is trying to build up here is something quite extraordinary. So the more momentum we build with, or he builds with PDI, the more prospect and the future of our profession really improves in this country. [Neel]Well, thank you, Jaz, it’s really good to hear. But that’s it, you know, we are trying to change the landscape is a battle. And we can do it together as a collective. And it’s just a matter of growing now, really, and I think, as we said, it’s going from strength to strength and really pleased that you’ve had a good experience and hope everyone, our members spread the word. But yeah, so really, it’s all about doing great dentistry, having great communication and having great people around you and that’s how you grow. [Jaz]And so and then your journey obviously, let’s talk about your journey into magnification did you start because because one of the messages I get quite, you know, and I’m always happy to help younger dentists out is even just yesterday, someone Instagram was like, I’m looking to buy loupes, should I get 3.5 or 5x or whatever. And I think when I was in dental school, and I was a student, I was actually at one stage. I think it was the student of trumping UK loupes. Yeah, I was saw like a Sheffield mercy rep for them. So I got I gained some you know, good knowledge about the different types of loupes and stuff and got into it. So that’s the most common question people in dental school just out looking to buy their first pair. How did you get into it and then what would you advise based on your past experiences and then we’ll come on to the whole scope and where that comes in as well. [Neel]We’ll definitely as you know, Jaz that you can only treat what you can see. And if we’re now as in dentistry, where you know, the nice really nice thing about Facebook is we are showing our work and it is setting standards and we want those, you know, really beautiful margin. And, you know, we want our dentistry to look natural. So although people, especially when you’re younger, you think you’ve got pretty good eyes, but you really can’t be magnification, and hand in hand with that goes illumination. And now as you get a bit older, you really need magnification, you also really need more illumination. And also what you’ll find is, you know, when you’re young elastic, you can bend into all sorts of shapes. And, you know, people have terrible postures, and they get away with it when they’re young. But you’ve really got to start looking after your backs. And I know it sounds such a trivial thing. But people’s leaving dentistry because their neck and back. [Jaz]Oh absolutely, I think we all know someone who will numerous people who fall away, at least cut down to part time to save their back. But it’s funny because we see these, you know how every time there’s a course nowadays, and there’s photos of people trying to promote their course got photos of, you know, Phantom head working sort of stuff or if you just observe all these photos, and you just observe their posture. And this is them being you know, the Hawthorne effect, you know, you change your behavior when you’re being watched. So this is being them being watched by their, you know, tutors and professors, or whomever is teaching yet they’re still adopting that posture. So you can only think what’s going on, you know, in real wet fingered dentistry? [Neel]Well, on the battlefield, yeah. It’s crazy. It’s really ridiculous, you know, we really go the extra mile for our patients, and, you know, you get the patients can’t lay back and, you know, we’ll twist ourselves into all sorts of shapes, and I’ve damaged my health, doing things like that. And as you get older, you become a little bit more, you know, confident saying, Well, now I can’t do that. Because, you know, I don’t myself my neck to suffer, so you work around it, your economics improves, the layout of the surgery improves. But generally, I think actually, although the work is probably the most important thing, I’d argue health is probably even more important. And, you know, if you’re suffering with chronic pain and neck and back, and you can’t work and you having to retire, then a scope or loupes ergonomics, although it sounds like well, from the others think about it, this could make or break your career and your health, [Jaz]This could add years on, I mean, my principal [Amic Mahindra], he raised a really good point, he once said to me, how much money do we spend on equipment per year, you know, obviously, I’m an associate, but you know, just generally speaking, we spent a lot of money on equipment, okay, you are the most valuable asset that exists in the practice you your hands, you know, your body, you need to really invest in yourself and your health. And I think that ergonomics of it is such a huge part of that. When I initially ventured into loupes, the promise was that, you know, there’s going to really help my back and adopt good posture, which it did. But I mean, I think one thing that I’d like you to touch on, because, you know, your level of expertise on this will be beyond mine is that, you know, after years of wearing loupes now that the angle of declination of your neck, once you try a scope, and you then notice a difference that for me was the game changer? [Neel]Well, you’ve definitely seen it yourself, you know, and as you said, once you’re aware of it, and it’s fun, even in the practice, you know, I take pictures of people’s posture, and I’m always pushing them a little bit here and there, and then you scan sit down and escape. And it’s almost gone from economy to business class. In economy all hunched up and bent over and twisted and no space. And suddenly, you know, you’ve elongated yourself, you get a little bit of distance from the patient, you’re not breathing all over them. I mean, just the health benefits of that. But also, I know it’s probably a weird thing to say. But I think mind and body follow each other a little bit. And if you spend, you know, eight hours a day bent over in a very negative position, you become a negative interest person. [Jaz]Oh, I’m a huge fan of that belief in I’ve read a few books whereby there’s something called forgot what it’s called, like, a power move. Like when you’re about to go into an interview you if you lift your body, your chest up, and you actually adopt a really positive superhero posture, that does wonders to your sort of confidence and your anxieties and your mindset. So I’m a huge fan of how the mind and body are connected, [Neel]I know. And so, with the scope at least you’ve got a chance to be upright, to have proper, not shallow breathing, to have circulation, to the air circulating, blood circulating, getting blood flow to your brain, and going home and smiling still and not shouting at your kids or whatever. [Jaz]This is the good sort of there’s still a concept now that we don’t have any evidence to support this. But it’s taking the findings of you know, the relationship between body posture and body language and everything else. So it’s sort of taken that across from one side to the other, I suppose, but you know, that it makes sense. So, when you’re now making suggestions, let’s say, I know where you know, we could this is completely unrehearsed we’re going to all these different tangents. But I want to draw it back to someone who’s young dentists getting their first loupes. What do you suggest? [Neel]Well, I would just you know anyone young especially for an associate you’re not going to invest in a microscope, at this stage of your career, you know, because microscopes have big, heavy, expensive, fixed object. [Jaz]But we’re gonna, I’m gonna touch on that as well, because I’ve been in touch with a few reps now. And some of these figures that are coming back to me, I read it know that they are actually that affordable. I always thought it was 40 50k Plus, but it’s like a 10th of that when you buy a secondhand, sure it might be a Chinese remake, but you know, it, they can do good service for a number of years. So we’re going to touch on that as well with the finances, the economics of loupes versus scope, because it’s not as skewed as I once thought it was. But yeah, back on the point young associate, you’re going to be getting most likely loupes. Okay, you know, let’s be real, we’re going to loupes. So what do you suggest? [Neel]When you’re in different practices, you move moving around, you’re still learning a craft, you’re still learning which speciality you may go into which that might change things. But yeah, gettin in to loupes really early on. And, you know, there are lots of good loupe manufacturers, and lots of very, you know, great expertise, and tend to be the loupes of manufacturers also tend to have a hand in microscopes as well. So, again, with dentistry, and with the whole thing, it’s all about relationships, whether it’s with the manufacturers, the suppliers, your reps, the patients, start building long term relationships with people. And you’ll be surprised how much help you get from people. So yes, I think you should you know, whether you’re a therapist, hygienist I’ve even seen dental nurses will loupes so [Jaz]Wow, I’ve never seen that before. That’s pretty cool. [Neel]A certain stage, you know, and again, the dentist wanted them to see what he’s seeing. And you know, and they’re doing, you know, point one millimeter kind of stuff to kind of help them with retraction cords or something [Jaz]Contact lense veneers [Neel]Fantastic. So, now, I definitely think you got to have loupes, and then people say, which ones do I go for, and there’s going to be an element to it ever, we’re all a bit different. So if some maybe go on price, and maybe go and quality, some may be go on own experience of other practices around them. I think really, first thing you have to do when you get loupes is make sure you’re sitting properly, because I had it with a friend of mine. And she thought these loupes just star she could see properly and all they would needed she needed more magnification or they needed the focal length to be different. But she was just used to that hunching over. So she got into a hunching over position that she normally sits in, puts the loupes and things. I don’t know these. So the first thing really, is get your posture sorted, figure out how you should sit, figure out what chair you should sit on. Get someone to check. And you know, when I was younger, we had really brilliant courses by [Alice Paul and Martin Amsoil]. And these guys, and we went along for a day. I think even in vt, we had some training about how to do four handed, how to do postural ergonomic. [Jaz]Yeah, he’s a big. Martin Amsoil. He’s quite well renowned in that field. I mean, I can’t I don’t see any more advertised courses anymore by him. I think they’d be great. But yeah, he’s certainly well known for that. [Neel]Well, he I don’t think he’s doing anymore. He’s got a couple of videos on Tubules, which are a good start. And actually, the guru now for me is a lovely lady called Jacqueline Boss, who’s Dutch physiotherapist. He’s worked with tons of dentists. And we did a global of kind of Skype sort of thing in with lots of dentists from Mexico and Russia and myself. And after hearing for about an hour or two, I just thought, you know, I need to get her over. So we nearly brought her over, we nearly did course. Just we had some slight issue with aid at closing one of their offices, which we’re currently using, when they were relocating. So it never quite worked out. But with still, you know, it’s gonna [Jaz]Watch this space, you never know if it comes out. I’ll put like a reminder onto the page or something. So watch out for that [Neel]Well after dental stress yesterday, and I think we’re going to do something. So going back to getting off tangent, excuse me, [Jaz]but this is the beauty of it. The beauty of where our thoughts and conversations leaders, but yeah, you’re saying fix your posture, [Neel]Get your posture, right. And then literally, you know, you’ve just got to try three or four of the lead manufacturers, and really look for what’s comfortable, you know, everyone’s got different size heads, everyone’s got different heights of torso. So kind of what works for you. What do you feel you know, it’s going to work in your hand, what’s convenient to you? What’s your price point? And definitely the students you get a much better deal. So really, the sooner you get them the better [Jaz]What stage of your career Did you buy your first loupes and which ones where they? [Neel]Surgitel. And it was probably this second year after vt. [Jaz]Okay. So Surgitel is very respected brand, obviously, I mean, mine was a bit different. I was a student so I didn’t have Surgitel money. I had more like the Chinese remake money and. My recommendation is okay. If you’re a student and you’re a normal student, ie, you know, the Bank of Mum or Dad, you know won’t be there to buy 5000 pound worth loupes for you. I would I think to get a 600 pound range of let’s say TTL Loupes, through the lens loupes , okay? And use them throughout, you know, two three years of your clinical sort of period of your dental school to get used to loupes. And then when you know, lets you first second paycheck just do it go invest in a decent pair of loupes I personally use 5x by Xenosys Korean company, I think Bryant are the suppliers for those, Bryant dental. But there’s loads out there. The only reason I bought that one is because the sort of the headgear that comes through is the only one that fits on my turban. So that’s, that was a big, game changer for me. So that’s what worked for me buying a cheap set, firstly, but not overly cheap, because I did actually dabble in the 60 pound eBay one and they just break apart something around the 600 pound range, I think the OptiLOUPE is a good brand to go for. And this is just worked for me. And then eventually you want to get a premium one out there. But now I’m in that transition now where to the presses are working, I’ve got a scope, I’m using that more and more. And I’m actually thinking about the third clinic and as an associate, I’m thinking of getting a microscope in that’s how much I’m loving now using microscope something, it’s transitioned. And I think this is the sort of, I think, the evolution of my education. [Neel]Exactly. You know, you sort of, you know, it’s like when you get a bicycle, you know, you start off with training wheels and tricycle and then you get used to that, and then you realize it’s human nature, we always want to see more, have better stuff. You know, improve dentistry. [Jaz]Magnification is like a drug you just want more and more honestly, like five times now is just not enough for me. I feel like I can’t see anything but even five times now, you know, I don’t know how even used to use three times loupes. I mean, I’m alone when I switch back three times now, as I can’t see, I would refuse to work without loupes now. That’s point blank. [Neel]Well, yeah, I mean, how many associates friends do we have, who carry the loupes around or, you know, all the different practices. And, you know, I remember one lady saying, Oh, she forgot them, and she had to drive an hour, just to go back and get them again. [Jaz]That’s and by the way, whenever we say loupes, we do mean loupes in light, you know, not loupes in isolation. I think that’s given here, whenever me and Neel are saying loupes, we actually mean the whole set of loupes and light because light is more important than loupe. [Neel]I mean, absolutely, Jaz, you know, if you know the to go hand in hand, really because, you know, unfortunately, we have to work after seven, it’s really dark in the mouth, you end up even with loupes not being able to see so then you strain more to try and get closer. You know, you get the nurses way. So again, illumination is a must and having a good overhead light as well. You know, I’ve got a nice a thick led thing. You know, just put everything you can get it illuminated. [Jaz]See. I stopped using my headlight now because my I’m so content with my loupes light but you know, that’s a good recommendation, you might find that combination works for you. So experiment, you know, figure out what works best in your surgery, with your conditions, with your light, with your loupes, and just get as much light in there as possible. [Neel]Maybe your nurse she’s not got that illuminate [Jaz]Yeah, that’s very selfish. [overlapping conversation] Okay, fair enough. Good point, point raise, and I think you win there. The next thing on a just to touch on is the statement, okay? That microscope is not a return on investment, you won’t make that money back, it’s not going to make you more profitable. Discuss. [Neel]It depends how you feel, you could say that about a scanner, you could say about a CT scanner, you could say about getting a nice a lecture versus, you know, a salon chair, you know, so everything we do with you got to kind of look at the overall picture. Now, for me, in private practice, I want to do the best job I can, I want to look after patients. And I also want them to appreciate what we do for them as well. So looking at the whole process of the patient comes in, you have a nice waiting room, you have friendly staff, he smile, you run on time, that’s all part of the process. But when they come into the surgery, and you may have a scanner, you may have a lovely surgery, you may have a comfortable chair, you may have digital x rays, and they go, Oh, wow, well, or they may have come from a really high in practice already. And they go well, this is normal for me. And then you pull out the scope. And you say, I’m just you may not have seen this before. It’s a microscope that allows me to see, you know, normally work between x6 and x12 magnification is the picture on the screen. And it just makes sure that we spot things clearly. And I’ve had patients in the pub because well in Philips, it’s an old Roman village, and I overheard someone saying, Oh, you can go to my dentist. “He’s, you know, I’m sure it’s gonna be for cheaper than what you’re paying.” And the patient went “But does he have a microscope?” [Jaz]Wow, that is powerful. [Neel]That it’s a little things. Yes, it’s a lot of money. But actually if you’re going to be in a practice, you’re going to look after a community of patients, you want to do your best for them. So firstly, do it for yourself, you know [Jaz]Do it for your back. Do it for your health [Neel]Do it for your back. Do it for your, actually I’d, [Jaz]You might be able to work more years and make more money. [Neel]Exactly. [Jaz]Just speaking out loud. [Neel]Well, there’s so many things, you know, you’re going to be healthier, you’re going to take more pride in your work, you’re gonna feel better about yourself, because actually, I’ve done some beautiful work in the past, you can say I can say that. And it’s not because I’m any good. It’s because I had illumination and magnification. And the patient will pick up, they’ll pick up on all sorts things I might pick up on the handsoup on the toilet they’ll pick up on the scope, [Jaz]Neel you say that, that patients will pick up, but I think it’s you as well, because I think there’s a way to communicate these things, you might have really good stuff. But if you don’t highlight it, it doesn’t actually get ingrained in their mind. So what you taught me when I came see you a few weeks ago at your clinic, was that the way you actually say, Oh, this is a microscope, you know, sometimes people will just pull out the scope and the patient’s got their eyes close,d mouth open, and you’re using a scope. And they might not even realize that there’s a big whopping machinery was being used, you know, if you say there’s a motion, I can see between six and 20 times bigger. You know, don’t be intimidated by it’s got bright light and just introduce him to him. And then they’ll when they go to a different dentist in future and they haven’t got microscope that’s when the value really generate. So you have to almost sing and shout about the beautiful technology that you’ve invested in. So I think there’s a communication point. [Neel]Well, you know, people spend so much on their Instagram and Facebook and trying to market patients but actually nothing beats word of mouth. And you create, as you know, we all know raving fans, you know, we’ve known this since Paddy Lund, you know, 15 years ago. So create raving fans create, you know, you look after your patient, but, you know, when you go to a car showroom, sorry to get back to cars, they don’t just say, there’s BMW, there you go, sir. They get actually, here’s a BMW, it’s got night vision, it’s got radar assist, it’s got this and it’s got this and you feel better value, I’m getting a car with all the features, I’m going to use them, it’s going to help me drive, that will help me be safe, that kind of practice. If I you know, fundamentally dentistry, it’s about confidence that patients, you can be a winner in all these cases where the works been rushed, but they’ve loved the dentist, you know. So it’s about trust, it’s about relationships. And if you’re adding to that relationship with the value, so things to do, basically, when you and your nurse are talking, just make sure your nurse picks you up a little bit, you know, not incorrectly, not dishonestly, but if you’ve done great work, and then nurses are saying that’s really lovely prep. There’s no harm, but they are Neil, that’s a really lovely prep for that. [Jaz]That’s a really good one. The other one, I do it. The other thing I do, and I think is I’m educating my nurse constantly, okay, so when I tell her, I’m using this wedge instead of that wedge, because I’ll find the teeth will separate a little bit more without distorting the matrix band, the patient doesn’t know what you’re saying, and that they’re like this jargon to them, but they know that I’m sort of thinking out loud, and I’m really going to the attention to detail. So at the same time, when nurses picking up this knowledge, she gets to learn why I’m making certain decisions. And then this just keeps them interesting. But you know, the patient see that, wow, this guy’s you know, just a little filling And this guy’s taking so much care and attention, [Neel]They’ll pick up on the vibe, on what you’re saying the tone, the professionalism. And also, when you want to tie a patient in to a practice, you don’t just tie in yourself, because you might have a good day, a bad day, you know, isn’t a big drop, but if they love you, they love the nurse and love the reception and love the practice. You could have an off day, you know, run a bit late, something could happen, but they still got investment in all over the people. And the other thing I do is when you know we’ve finished the film we’ve done through post operative instructions and we’re escorting the guests back to the reception. I just turn around say thank you Joan, thank you Ramona, Thank you.. No, I’ll thank the nurse and [Jaz]I noticed that you’re very good at doing that as well. That’s very good. [Neel]And that gives them the audio cue for the patient the patient and gets Oh yeah, thank you as well and it just reinforced that actually you’ve had a service you know it’s not you’re here under duress and we’ve you know assaulted you in your service you know? [Jaz]Absolutely. The other communication tip I have is since we’re now talking about is I like to call this i’m sure someone’s maybe written about this but if they haven’t I’m going to claim this one okay. I’m gonna call it “diva mode” So going diva mode means right your nurse hands you let’s call it she hands you a wedge. Right? You pick this wedge up and you don’t like this wedge and say like “I don’t like this wedge. Okay, give me the best wedge you have, give me the other one. I want it to be perfect.” I think that really adds value is on a patient wow you know this guy is so picky he’s so in you know in trol they’re making this perfect phrase that I call that diva mode. So if you haven’t had that before, that’s my invention Diva mode. Go diva mode now and again. Unknown SpeakerWe’ve changed it a little bit because it was really greatest respect. I had actually, I’m sure my endodontist, well endodontists are a different breed of dentists as we know that They’re very special people, very precise. And you know, a good one is very anal. So we had our endodontists are saying, Oh, no, I don’t want that one, that don’t like that one, find me [Jaz]They’ll upset because I won’t get the quality that I want or something to that effect, you know, [Neel]I think I’d probably say, you know, doing that. So that’s a really great one wedge, and that works really well, most of the time. And actually, for our lovely patients, you know, David, whatever, because he’s got this unusual anatomy, I will get a much better job if we have this wedge. And could we have that? So you don’t denigrate what you’ve got to say that Actually does brilliant. [Jaz]Well, of course, you are so smooth. Oh, my God [Neel]The practice we have is great. We don’t have the stuff that we just actually done. And you don’t want to do it. Actually, you know, you’re absolutely right. That’s a fantastic wedge that we use for most of the time. And as you know, we have such amazing products here. But actually, we have been, you know, the contracts we are we’d have a choice. And actually that wedge for you would be much better. So I wouldn’t denigrate any. [Jaz]So the take home message everyone is don’t go diva. Go diva light, the light mode will be amazing. [Neel]I know what you’re saying. You’re trying to get across that point of excellence. [Jaz]Yeah you increase the value of what you’re doing. And you’re really demonstrating that you really care. And I know the people you know out there. Excellent dentists who really care and sometimes need to show it to the patient. So Neel before we digress too much. couple more questions. So to get back on track, it’s so communication pearls there, that is what features to look for in a scope because I was in the market for a scope. Before I realized I probably have to delay by year for finances. And I was offered one without a I think it was called it. It was a fixed head. It was a fixation. Yeah, there was no inclinable head. And I saw I asked you for your opinion. And for someone who’s like a restorative dentist like me, it’s no good, you need to be able to incline that head. So can you tell us about which features are absolutely mandatory? And, you know, if they don’t have it, then it’s not really worth investment, Can you give us any enlightened on that? [Neel]Well, I think generally, if someone’s buying the scope for somebody else, like a principal is buying a ticket for an endodontist, they probably don’t do the same due diligence as if they were using it themselves. So I think it’s only fair that when you look at the scope, you think, would I be able to use this. Now endodontist generally don’t need as many features, let’s say because they’re basically 1/3 of the canal, they kind of gain on muscle memory, and you know, skill. But for any restorative type dentist and I do you know, as I said most for my work with the scope, even all my exams, my kids exams, everything. So for me, I really want that flexibility that I can use it in all situations. So the scope itself has to obviously have a great lens. And there are different and lens qualities. And if you can look through that, you know, go to the show and look through three or four or go to your friends practices and look through a few, you’ll see the lens quality. So that’s a must. Illumination is led versus xenon. Xenon’s brighter, a bit more yellowy, and the bulbs are quite expensive. But if you want the really bright light, maybe you’re getting a little bit older, maybe you’ve got a lot of cameras and magnification and other things going on on the scope. Xenon is good. But wherever they really in terms of cost LED lights are really cheap. They’re bright illumination they last a long time. So an LED light is good. You want some ability to take pictures, you know as you’re building up your portfolio as you’re showing patients so whether it’s a beam splitter that can take an SLR whether it’s got a built in camera, some of the older cameras aren’t so good as you know things change the new Zeiss extaro got an amazing camera but technology changes [Jaz]Don’t get me started on the Zeiss extaro Oh my God, I mean, literally, that’s a dream if anyone hasn’t seen or heard of the Zeiss xR Oh, that’s e-x-t-a-r-o Zeiss. It’s got this function this light the fluorescence mode, which it makes like you know when you’re like out in like a UV rave nightclub, and your composites go like fluorescence, they’ve got a different color, you can actually see that in the chair. And then all the flash of composite that you can see, you can see calculus, plaque that just blew me away. And also the the light actually, the normal sort of white bright light doesn’t cure composite. So these are just two of the features I know about the extaro after using it, it just blew me away. [Neel]I know. It’s fantastic. And that’s definitely one for if you you know, you’re starting a practice they’re going to be there 10, 15 years, you know, you put the investment in and I think we’re going to one of my friends [Jaz]That’s about 70k you know that’s that’s good but all in I know what. When you add in VAT, and then all that all those sort of specs and stuff. Yeah, maybe that’s okay. Probably not as much 70 but it’s a hefty investment. But you know, I asked one of the reps and you’re looking at roughly about monthly payments of about 700 pounds is just just to give people a little taster. That’s why I use this device. [Neel]Well, definitely that’s the real choice. I mean, they used to have the size per worker which is even more expensive. But and that was 70 grand. So actually, they’ve come down in price. And it’s become better as most things do. But generally, you want the adjustability, you want good light, you want things like various scope, you want [Jaz]What’s various scope? [Neel]So basically, you’ve got a few things, I mean that I don’t want to talk too much about this particular device. And we’re going to be fair to global and caps and things. But generally, different manufacturers have different terminology. And what they’re basically saying is, how does the lens move? How does you know the positioning? Will it tilt? Will it turn? What magnification depth can you go to zoom? Is it if you know, a fixed lens? Can it click so there’s all sorts of different things. I’m afraid I can’t give you the magic answer just straight away. But you know, anyone looking for escape, they want to email me or, you know, give me a call, [Jaz]or go on the BAMD Facebook page. And you know, post your question or message or just post question because someone else probably thinking the same thing. And there’s so many great, amazing international dentist on that. BAMD Facebook page would be just happy that someone else is joining that little niche club of microscope using dentists. And they’ll be happy to help you. So post any questions. I mean, the take home messages, you do need a bit of expert advice when you’re buying a scope, which is such a big investment. And you know, things like is the head is incliniable, the lighting, the ability take photos, these are all really important considerations to look into. [Neel]If I can just interrupt, Jaz, the thing is people you know, like yourself, you were saying, Oh, I found a scope and it’s a secondhand one. Just be a little bit wary if it’s a one that’s already more mounted, which is actually the best way it costs you a couple of grand to get that off the wall delivered to you without the lens being upset and then remounted. And I’ve seen people who’ve gone, tried to save some money, bought a used scope, and they could have got a decent quality new scope for what they paid in terms of transportation. Easier if [Jaz]Yeah, those extra fees, they can [Neel]You’d be surprised. I’m not. So I think with the, you know, the freestanding ones, obviously easier to move a position problem and they tend to be for endodontics. You know, once a week they get dragged out. But problem with those is one they’ve got bulky footplate. And two, you’re not going to use it again, as you know yourself. If it’s in the cupboard, you think I won’t get it out. If you’ve got it wall mounted in front of you, you’ll use it. So just be a little bit wary of use scopes or add, you know, if it’s a starter scope, then you think, Okay, this is what I’m going to do, then I’m going to sell it three years, and this is the plan, but just be aware of hidden costs of transportation, and the manufacturers don’t really want to help you move it because they take a such a liability if the lens distorts, you can say Oh, and it’s through travel and you know, it’s a precious item, these things and, yeah, [Jaz]See I know, I never would have thought that [Neel]and probably three or four grands worth. Three or four grand extra to transport and mount and deliver. [Jaz]So last one last thing, then is already when I’m taking photos, which I take loads of photos with my you know, 5x loupes, they’re really long, to telescopic if you’d like, it’s not as easy take photos with my loupes on sometimes I usually just try and keep my loupes on while I’m taking photos, okay, it’s a bit of a hassle. But with the scope, you know, unless you’ve got a really great system of the camera being integrated into the scope, you have to I have to move my scope out the way and then you know, take photos. So you may need to make these things easier. You know, photo taking should be easier, you should have your camera ready anytime you want to use right. Anything that will slow you down or be a hindrance will reduce you, will lead to you taking less photos. So any tips for getting over that hurdle, basically, of how difficult it can be from transitioning away from this microscope. Getting a camera is just a hassle, basically. And we all know that microscope photography, although it can be good. It’s really difficult to master. [Neel]Yeah, I think I mean, lots of people have difficulty with taking pictures and images. And again, when you’re setting one up, make sure you get spare cables built into the wall, make sure you get it mounted to a big TV screen. So you know the things that you’ve really got to get set up. And it’s all in the planning. But generally a scope will give you a great still images. But actually I would sometimes I’ve got a beautiful intraoral camera which one is it’s, I can’t remember the name, start to three grand it’s quite expensive Iris and you get beautiful images from that. So I will keep the scope there. Just pick up the iris takes me three seconds. Okay, that’s a good one. So I’ll sometimes just use the iris and the iris is such an amazing camera. It’s a bit of a sight. It’s so expensive, and if it needs repairing ask about the state. So there’s probably other ones around but that wins the awards every time and when you see the images. And to me again you think well it’s a return on investment but the amount of time the intraoral camera where I’ve got a picture of the crack or I’ve got picture the tooth patient comes back six months later though that tooth we did is hurting and you go well actually I did the one next to it and here’s a picture and blah, blah, blah, or something flares that [Jaz]I mean, we cannot, we can just go on and on about photography, that’d be a whole different. I mean, this is so important. But that’s why it’s important to if you’re thinking about loupes and scopes, also think about how you’re going to factor the photography into it. Because I think those dentists who are even thinking or investing in loupes and scopes, you care about what you do, okay? You want to be proud of the work that you generate, therefore, you probably aren’t taking photos of your work. So they all go hand in hand, that means to have a little plan of how you’re going to be able to see more, but also photograph more, [Jaz]But definitely use your scope, get a great intraoral camera, and get your SLR and getting this trained on the SLR so that you know how to take them. [Jaz]That’s exactly one way to lead to is essentially, if you’re the one who’s doing all of it, and if you’re having to move the scope away, and then pick up the camera, if it just moves go away, and the nurse is ready to take a photo and she knows what she’s doing. Or he or she you know, it’s that is I think the way to go? [Neel]I definitely think look, you know, nurses are very competent, capable people, they, you know, let’s face it, they don’t do it for the money, they do it for the love to help people. to care, to be part of a team. And you can nurture that and you can reward them. And you know, you’ll know when you’ve got a great nurse, and it becomes a partnership, and we’re talking about Martin earlier and hand in hand with Martin his nurse, long standing nurse, Sally, and, you know, they’re a team and you know, when you do have a great dental nurse, you know, get them involved, if you say and talk to them, and tell them what you’re doing, nurture them. And, you know, again, it’s a chance for you as a dentist to make a huge difference to someone’s lives. So, look after your nurses respect them, they’ll respect you, and they will want you to succeed. It’s amazing how you know, they have that nurturing element to them, they want you to do well. So you know, create that relationship, you get them to doing the cameras, you know, get them doing the impressions getting taken the X rays, thanking them in front of the patient, you know, these are all things that really, you might think, you know, they actually come back to you tenfold. So, you know, [Jaz]Neel, that’s amazing to take home messages, get your nurse to take photos, or make them look much life much easier, whether you use loupes or microscope in having that help. And you just gave us so much more than just, you know, loupes versus microscope today, you gave us amazing communication pearls. And I think everyone listening today would really benefit. So thank you so much, Neel, for today’s podcast [Neel]I think we’re probably gonna have to do another one on scopes. [Jaz]Now, this is exactly what I wanted, like an introduction, I want people to not dismiss microscopes, I think it’s so easy to be a few years qualified or been using some loupes for a few years. And then thinking automatically, okay, which loupes should I now upgrade to? But actually, I want to put this out there actually, you can, you know, consider using a microscope more and more, and that will do wonders for your posture and your dentistry. So I’m just basically, I’m very pro loupes, but actually, no, I’m pro magnification. Okay. And I want people who are the set in their ways about loupes to really get out of their comfort zone and consider microscope that will just, you know, just be a massive game changer [Neel]You know, there’s a bit of a learning curve with a bit of cast, same suit for the [Jaz]I was scared. I’m so scared of the microscope. I mean, I’m getting better now, basically. But that little thing in the corner, which I use to hand things on, but now I’m actually using it more and more. And it definitely is scary. Even when I bought my 5x loupes, and then was an upgrade from 3x. I just spent all this money. And for two weeks, I was scared to use it because it was just out of my comfort zone. And then when I started using it and you know, after the hurdle about the first week getting used to it, now I’m like, you know, I’m constantly glued to it. It’s the same thing with the scope, you need to book a little bit longer for your patients to start doing some exams. Like, I’m just amazed to do two pediatric exams with microscope. That’s a great tip, I think and just go out and use the scope and I promise you, you will love it. [Neel]And definitely, you know, think of it’s part of your career, you know, it’s part of your life, part of your health, part of your patient care. And you know, it straightaway you become a different. I mean, I felt when I went to Spear or when I get to Pankey, Dawson, Kois, immediately even just by turning into course, I’m doing nothing different. I am now in a different echelon of dentist, not that I’m any good. Not that I’m bright but I spent the time invested in that, and I’ve become better. And the same as scope you are immediately in a different category of dentists. People use scopes, we know who they are, I know they are. They’re great friends of mine, they all use scopes. And they’re straightaway they’re elevated into that next Echelon. So if you want to get ahead you know if you want to be one of the top dentists, doing great work and proud of your work and helping patients. I honestly thought you needed to get a scope. [Jaz]Absolutely and when I think of dentist that use scopes Okay, I mean, I do hold them in high regard because if I’m referring a patient to okay there’s a there’s a guy in Hong Kong a dentist, a really cool dentist in Hong Kong right who loves using the scope. He has a scope for his hygienist. Okay, so his hygienist using a scope, right? And then he emailed me saying, “Listen, you know, you’re part of the operations manager, BAMD, if I’m ever looking to refer any patients to England, because I have some Patients often traveled to England and then the might need a dentist, is it okay if I refer to you because obviously, the fact that you use a scope tells me that you’re a good dentist” you see what I mean? It’s like that, it raises your the value of that clinician. Because if they’re using the scope, you know, they’re really care about. [Neel]You probably if you’ve got loupes and someone hasn’t got loupes, you probably think I’m probably the best dentist, not the normal best dentist. Not that I know more and yes, but you’re everything naturally. They don’t use loupes, you not saying you look down on them, but you kind of think you’re not using loops. And that’s how I, you know, that’s how we should feel about my people not using microscopes. And there’s definitely a place loupes where [Jaz]I agree, once you join that club, you do then start looking out for other dentists who use a microscope, and then you sort of keep it within that little circle. It’s just, it is what it is. I’m sorry, guys. [Neel]I mean, you know, look at [Monder upon McClelland or Tony Druckmann,] or, you know, all these guys, you know, Hap, Hap Gill. Top guys do beautiful work, care about what they do. Very, you know, decent guys who are humble, they just want to do the best work and they want to look after themselves and their patients. So definitely, look, it’s a big learning curve. But we’re here to help. We’re here to give you advice. We’re here to help you with ergonomics. And again, as we’ve seen from today, we can help you with a whole practice environment, you know, and pass on our knowledge that we’ve learned through our own mistakes. And really, it’s a holistic approach to dentistry. [Jaz]Thank you so much, Neil, for joining me today. [Neel]My pleasure, Jaz, you take care and have a great day. Jaz’s Outro: Thank you guys for listening. I hope you enjoyed that interview with Neel Jaiswal. If you did enjoy it, please subscribe on iTunes or Google podcasts or wherever you listen to it. Please like the Protrusive Dental podcast Facebook page. So I can keep tabs on people who are interested in my content, gone website, jaz.dental to download any show notes, my future shows. I’ve also got something for students coming up. It’s called How to Ace your dental exams. I’ve got Prateek Biyani coming on that so that’d be great to catch up with him as well. And I’ll catch you the next one. Thank you.

In this podcast episode I am joined by Dr Dhru Shah, Periodontist and founder of Dentinal Tubules. Have you been thinking about a change of scene, or to move away from the shackles of NHS Primary care Dentistry? Need to Read it? Check out the Full Episode Transcript below! Many Dentists have considered making the switch to Private Dentistry. We discuss what it takes in terms of: Investments Mindset Education Early career choices Mentorship Above all, make sure you go in to any new career choice with decisions based upon PASSION, not upon FEAR. Click below for full episode transcript: Opening Snippet: Welcome to the Protrusive Dental podcast. The forward thinking podcast for dental professionals. Join us as we discuss hot topics in dentistry, clinical tips, continuing education and adding value to your life and career with your host, Jaz Gulati... Jaz’s Introduction: Hello everyone, this is Jaz Gulati here. Thanks so much for tuning in today. And thank you just gently for the lovely words of encouragement and support I’ve been getting so far, it’s been so much fun doing this, and I’ve recorded quite a few episodes now I’m just finding the time to edit it really. So today’s a really great episode. Whether you’re you know, driving, on a journey, in a commute or having a cup of coffee, listen to this, I think this is going to be really helpful to people listening out there, to young dentists but also to experienced dentist, this is all about a transition, a change, a change from whichever environment you’re at the moment to a different environment of let’s say, clinical dentistry or place in life you want to be and typically, you know, the the crossroad you find is, or a decision you have to make is a transition from NHS dentistry, for example, or whatever type of practice you’re in the moment to something better be it private, or in a mixed position or summer with a better mentor. Today is all about an interview with Dhru. And we really do discuss a few step stones and a few ideas of how the young dentist or even the experienced dentist can make a change from what they’re practicing in the moment to where they want to practice. It’s interesting, I was on Facebook and I was reading one of the sort of dentistry groups or on someone made a comment in a thread about you know, being an associate versus being a principal. And the comment was from a principal who said that, I think associates are lacking ambition nowadays. Okay? So fair enough, but I’ll rephrase it for you. Okay? What do you call an ambitious associate? Okay, it’s called a principal, right? So I think all principals have to accept the associate mindset, okay, that they’re not going to be as I would even say that associates cannot be as ambitious as principal you totally can be. It’s just a different set of circumstances, different places in life, whether you want to be a leader of a practice in that sense, and whether you want to own a business or on a business. So I you know, just because you’re not a principal, doesn’t mean you can’t be ambitious. And that’s sort of one thing I want to discuss about today. But for associates, I want to give them a bit of a tip as well, as an associate myself, I like to think that I still do my best and I sort of treat the business as if it’s my own as well, within reason, I think when an associate really, really cares for that practice, and cares that business and looks after materials and helps the lifts, practice morale, and even contributes outside of the working hours in any way at all. I think it’s really, really important to do that to show you that you are a team player, because ultimately, the success of the business, success of the practice is your success as an associate as well. So I do think associates, if you think that you’re just there to do a nine to five and come back and you’re not really doing anything to market your practice or to support the principal, then I think, you know, that’s not really cool. You’ve got to up your game, but principals, you got to make sure that the relationship exists for your associates be able to be ambitious in their own way and get rewarded for in some way or another. Today’s Protrusive Dental pearl relates to this episode. And basically it’s primarily to associates but there’s a bit for the principal here as well. Okay? So I see this scenario quite a lot. The pearl is this basically, I see this, put it through as a form of scenario and I see it quite a lot. Okay, let’s say you’re doing a postgraduate degree in orthodontics, for example. Okay, just started it, you’re learning quite advanced level now and you’re hoping to start some complex cases. The only problem is that you’ve got all these lists of materials to buy, and you’ve got these pliers, all these different archwires, NiTi, stainless steel, different types of bendy things, elastics all sorts, okay, in your knee, and you’ve got some patients, you may have some patients who have agreed to go ahead with treatment and you’re excited. It’s boding really well for your sort of clinical education for towards your degree. Because you know, experience is so so important. If you go on any course and you don’t implement it, then you don’t really learn anything from it. It’s the same with any postgraduate degrees, you’ve got to be implementing practice. So let’s say you’ve got patients lined up ready to go except you can’t carry on you can’t proceed because you’ve now sent an email to your practice manager and principal or you told them face to face or all codes, all the materials that you need, and that’s reviewing it and that I mean, our ring, and they might say no, or for whatever reason, or they might say, okay, let us think about it. Let’s discuss it as next staff meeting. You know, it’s 1000 pounds worth of equipment. And you know what, I think they’re within their right to not hastily buy things if you know, associates nowadays, can come and go and imagine investing so much in an associate and you know, the next month they’re gone or whatever, you know, not, that you know, this happens often or commonly or maybe it does. I’m not really sure what the what experiences principals have had out there, but I totally get it when an associate goes in a new course. And they have this new list of, you know, get me this articulator so I can do this all cases or you know, all the materials I mentioned. And suddenly, the principals have turned around, say no, or just wait a moment or wait for the right time, wait for a few months. So it puts the associate in a difficult position because you’ve got these all these cases ready to go, right? Well, associates, listen, go ahead and buy those materials yourself. Okay? It’s going to be tax deductible, firstly, so the sting is not as much, okay? And the most important thing is that you get to start treatment now, okay? You get the benefit of the increased revenue. But more importantly, the educational benefit is so, so important. And it’s important start now, not tomorrow, not in a month, okay? If the only thing holding you back from implementing new knowledge is materials that your sort of principal or your practice manager has to approve, and that’s slowing you down. You need to just, you know, just bite the bullet and buy yourself, okay, then after you’ve done a few cases, you increase your revenue, okay? And then you can actually present evidence to your principal and say, Look, I’ve done so many cases, you know, I’ve proved that I can do it. I’m excited and ready to do some more cases. Can you kindly now consider buying me all these materials ASAP? You know, I don’t think a principal who’s worth their salt would say no. Okay. And he worked for corporate, it’s the same. If you can prove that you can bring a return on investment. Right, then I think any principle, any corporate would would say yes to. So I’m hoping that associates are not finding themselves in situations, such as this too many times. But if that’s holding you back, okay, you need to act now by yourself, start the cases, learn, enrich your mind, enrich your wallet, so that you can then invest further. Okay, so that’s my Protrusive dental pearl and I think it ties in really well. I hope that point comes across and it’s actually a real life scenario for a lot of people I meet. So let’s join the interview with Dhru Shah now. We’ve got some really great gems in here, I think’s gonna help a lot of dentists, whether you’re from the UK, or from the US or wherever, basically, because you know, for example, in the USA, although you don’t have the NHS, you know, you may be a dentist who’s looking to work in a better practice in terms of being less based around insurance, for example, and changing the environment to this episode is all about how you can bring about that change, what steps I think, what steps Dhru thinks are necessary. We’ve all been through this journey ourselves. And Dhru ‘s helped so many people out there. So I think you’ll love this. So let’s have a listen. Main Interview: [Jaz]Dhru, you’re you know, you’re a man who needs no introduction. You’re obviously if the founder of Dentinal Tubules is doing awesome. It’s one of the things, one of the reasons I got involved was, you know, because of your sheer inspiration. And the reason I want to speak to you about this topic was I’m pretty sure that, you know, in the UK, you’re probably someone who’s helped the most amount of people with this, you know, topic that we’re going to be discussing today, which is transitioning into private practice, I’m pretty sure you, you know, mentor, or help, either through Tubules, or, you know, giving up your own time or mentoring. You’ve helped people into private practice. I mean, would you say that, you think that’s fair to say? [Dhru]It’s, I would hope so. I mean, I have helped people with gaining the right skills, perhaps, you know, in the right direction. I’ve never actively ever pushed people to say go into private practice. But I have always tried to encourage people to deliver good quality patient care. And with the system we are in now, I think invariably, that’s where it lands up, that they end up in private practice, because that’s where they can deliver that kind of care. Now, that I think that’s a sensible way to go. [Jaz]Yeah, so private practice, it’s like a surrogate outcome of, you know, getting people to do be the best dentist, they can be. Right? [Dhru]Correct. That’s, I think that’s the best way to put it actually, it is that. And ultimately, that’s what we know, that’s what we are about. We were about looking after patients. And if something stops, you’ve got to find a way in which you can do it better. [Jaz]That’s true. But I think we have to just start off by saying that, you know, this is not slagging off the NHS. Okay. I mean, this is not what this podcast is about, right? We’re not we’re not here to slag off the NHS and condemn everyone who works within it. I think the NHS has its place and those who work in mixed practice ownership. I mean, they do an amazing job. I tried it, I certainly couldn’t do it as well as they can. And you know, not everyone, not every young dentist listening to this needs to feel as though they need to be in private practice. I think should we just clear that out? [Dhru]Yes, absolutely. I think it’s a good thing to say that yes, they do. It’s not either, but that’s where I always sort of say, you know, it’s not a bad private practice. It’s about delivering good care. And if you know if you feel that you’re comfortable, delivering it within the system of NHS with the Practice you are and you don’t have to go private, ultimately. It’s what you feel comfortable as an individual. It’s what you feel happier as an individual. Private care isn’t about, you know, a lot of people think when you talk private dentistry, a lot of people think, Oh, that’s a higher level of dentistry. [Jaz]They think of Facebook dentistry. [Dhru]They think of Facebook dentistry, that smile designs, they think of the fact that I’ve got to charge more. I mean, I know people who said, you know, I’ve never done private dentistry, because I feel I’m not worth that extra charge money. And I said, That’s not private dentistry, you charge more maybe because you take more time, but private dentistry, is actually just doing the same thing, just that sometimes you feel I can spend a bit more time may be doing this. And therefore I feel better. I mean, if you think I’m a very slow worker, it takes me, you know, I’m not the fastest person in the book, no doubt. But private dentistry, for me is about that time. Now. A lot of people I worked in the NHS for a few years after graduating. And I know a lot of practitioners when the big practice I was in. And they were also very, you know, very good at delivering if they didn’t think that they needed to go to private dentistry. And I think that misconception has to be changed. Like you say, you know, it’s not Facebook dentistry, it’s doing the bog standard, basic daily work, [Jaz]and doing it the best you can and but you know, I mean, you have to say that, you know, when I was in DF1 or just out of dental school, I had this preconception that a private dentist or private dentistry, if you’d like, is like, it’s always going to be awesome. Like, if I thought, all right, someone’s had this done privately, then it must have been just amazing. It’s not, I mean, you know, more than anyone that’s just far from the truth, right? There’s plenty of amazing work that’s done on the NSH, and some plenty of shoddy worked on privately. But on the whole, you’d think that the people, the type of dentists that go into private practice, they’re able to spend more time on it, invest, you know, time is such a crucial factor, when you’re delivering good bespoke quality dental care. [Dhru]It’s that I mean, you know, I can expand that a little bit more. I know, we are talking NHS and private. And I know, we’re talking that’s something very UK specific. Right? [Jaz]Exactly. [Dhru]If you think about it, if people think a bit, sort of thinking wider, and you bring a slightly different topic of dental tourism into this, so you’re talking about, you know, people going off to Eastern Europe or Turkey or other countries to have their dental treatment done. And we get this misconception in the same way that Oh, they’re going to those countries, it must be crapped industry, but it’s not. And it’s the same thought process that, again, it boils down to there are certain clinics out there that just deliver top quality of care, that has an attention to detail that isn’t about private dentistry, it’s the focus is back to where we start, which is quality of care. And the quality of care is what ultimately, we are aiming for. And it’s finding the solution to that. Now, a lot of people move into private dentistry because they’re not constrained by two things. One is the time. And the second, well, you’re still constrained by time, you can’t spend forever on something. You know, but the time constraints are different. [Jaz]And the contract. [Dhru]And the second thing is regulation, and the contract rate regulation, you know, NHS is getting more and more bureaucratic. And I think that’s where the frustrations lie. Sometimes I understand that, [Jaz]you know, you know, Dhru when I see those Facebook post saying, am I allowed to claim this? Or I’m allowed to claim that? Or is this material allowed? I’m so glad I don’t have to deal with that bs anymore. [Dhru]You can say that, you know, the other day somebody was talking about a course of how to you know, we’re running a BD IC or something about how to claim and understand the system and people saying different things, you know, why do they Why do people have to pay for this course? Surely, if they’re working systems paid for free, I said, the most disappointing thing about this is people working in the system have to spend time away learning about the system, when they should be learning about the skills and knowledge to be able to deliver better patient outcomes. You know, I mean, [Jaz]That’s well said, [Dhru]You know, you, that’s what I’ve stood for over the last 10 years. I mean, I worked within the hospital and not criticizing the hospital. But I almost quit dentistry, because of the bureaucratic nightmare that the hospitals used to be. And I understand they’re probably even more bureaucratic now, I guess. It’s not easy for anybody to function within that and that’s not how you look after patients. It kind of you know, how bad in great pisses me off. We’re here to look after patients, cut the paperwork bullshit out and let us get on with the work we do. [Jaz]So Dhru, let’s just dive into that. That’s exactly why I wanted to. When I came back from Singapore, I want to only look at private practices. And when I was looking for a job, and you know, you were amazing in terms of helping me as well, you put me in the right contacts, and I now work in practice in three clinics. And I’m very happy now with the balance I have. And I certainly wouldn’t be able to do the treatments I’m doing now, if I was sort of bounded by a contract, or certainly I wouldn’t be able to do it ethically up me, this is me. I know some people can but this is I’m talking about in the individual level. And it’s interesting, because when I was getting advice from you Dhru, I had like a little bit of like an imposter syndrome going on this time last year. I don’t know if you remember, I was messaging you. And I was like, Dhru, I don’t think I could do this. Like, Are you sure you think I’m good enough? And I had that. And certainly when I look back on it now, one year later. I’m totally good enough. I know, I think that, you know, if you have that voice in your head saying that, Oh, I’m going to stay in my comfort zone, I’m going to stay in the same place I am, then that is really holding you back. And if you think that you want to work in a different environment, ie private dentistry, then do not think you’re not worth it. I think with the right attitude, anyone can do it. [Dhru]Yeah, I think you’re right. Absolutely. And that’s why I said you could because you know what? The best and the biggest growth comes when you’re inside the box. Always. I mean, I’ve learned that in the last 10 years, I’ve you know, I’ve been right on the cliff edge, and somehow pulled myself back from it. And I realized that’s where the biggest growth happened because you’re pushing your limits and potential. And we don’t do silly things. Fair enough. But [Jaz]This is my favorite thing to talk about, Dhru, if you’re comfortable, you’re not growing. [Dhru]You’re not growing, you’re not growing at all. And but this is the other thing about so. I’ll tell you a story. And the story is of a dentist who worked in NHS dentistry within the UK. This dentist then moved back abroad back to their home of abode where they had no public health care based system. And this dentist messaged me and said, I’m not getting any patients. I don’t know what to do. My bosses are not giving me any patients and I’m meant to be an associate here. And when they do give me patients, they don’t help me. All sorts of things like that. I said, Yeah, because number one, in the UK, when you put that big board out there NHS patients walk in, [Jaz]yep, gets the punters in. [Dhru]So one of those challenges one state but one of the challenges is, is if there was no NHS, you had to stand on your own two feet, you would immediately start learning marketing skills, you know, skills that and make people aware of your presence. The second thing she said is, you know, my bosses aren’t give me patients, I said you will have to find all the patients. And you know, what happens as well is because this dentist had to find all the patients, when the patients come in, in an ultra competitive market. She has to have all the skill sets. So this dentist in have skill sets of implants or you know, advanced preparations. Now this dentist had to go on these courses. So what I suggest is, because otherwise the patients will go somewhere else, right? Yeah, in those countries, you don’t say I’m going to refer you on because when you say I’m referring you on, the patient’s go, this person doesn’t know what they’re talking about. I’m going to go to somebody better. Now, ultimately, so what when you talk private dentistry, it isn’t about just patient quality of care, it’s about the fact that you don’t have that umbrella of the NHS anymore, which brings the punters in or you can refer this, you know, people you don’t retreat. Ultimately, it grows you personally and professionally. And that means you pushing yourself out of the box. So it is a mindset you need to have and you’ve had it that’s why I said you’re ready for it. Right? I was not talking about sales. [Jaz]And I appreciated your push in the back, you know, you gave me the kick. And I needed that. And I think if you’re listening to this at the moment, and you need that kick, go for it, you are totally worth it. You know, if you’re even considering private practice, you’re probably someone who’s really passionate about dentistry, and you don’t want the NHS to ruin your life. And again, I am not slagging off the NSH here, it’s fantastic work done. But this is specifically for people who are considering it, but they’re just not final push [Dhru]I think so. I mean, we wouldn’t select the NHS off, but we know their constraints. And I think one of the biggest things that dentistry needs to do now is really grow. I think the situation is that stage where if they don’t grow, they’ll be doing themselves an injustice at a certain level. And they’ll be doing the patient’s an injustice. that’s ultimately what I see. [Jaz]So it’s simple swim in for the future, I think. So I want to talk to you a few more topics in particular. One I’m going to get on to short while is that when is the optimum time for a new graduate or anyone to go into private entry. But before we get onto that, I wrote down a few things, which I thought were important for me when I was making that transition into private practice that some things that I told bullet pointed, many years ago actually thinking right here are things I need to focus on. And it’s things that my mentors taught me. A lot of it, Hap Gill, taught me and lectures and whatnot, and you know, lots of these influential people. And I’m just gonna list them here, Dhru, and you know, I’m going to add you to this list, if you can think of anything we can expand on these. Okay? So first one is investments, okay? And to me, that’s investment in loupes, magnification, illumination, photography, okay? It’s courses so you can advance your education, so that you can not have to be a glorified therapist, you can actually be doing proper dentistry, you know, beyond single tooth dentistry, so that you can learn to diagnose so that you can learn to communicate so courses encompasses so much. And also, that feeds back to investment because investment is also a significant amount of money. I think. I’ve spent, you know, ridiculous amounts of money, but I’m happy for it. I’ve seen my income grow, you know, year on year because of it. And I think investing in yourself in your education is one of the most important things. Okay, so that’s, that comes part and parcel that. The next one, Dhru is having mentors, okay. Being really good with communication with patients, and also with clinicians. And the last one is, which really helped me was having a good portfolio. [Dhru]Yes, I think. So, it all ties in into a long, you know, a story. And there’s one final piece of the puzzle that you missed, or probably you had it, but you didn’t realize you had it. [Jaz]Perfect. No, tell me this is this is amazing. [Dhru]This is the puzzle, right? So the first thing I said is you’ve, in fact, I’d say you, you know two things at either end of what you said, the first thing is the mindset, if you don’t have the mindset, you can invest your life into things, but you’re not going to get the results out of it. And when I say mindset, you have to be ready to have that mindset that I’m going to do things that are challenging, and it’s going to be tough, but worthwhile. The second is a mindset that yes, I’m now going to make that change because I’m ready to grow. And doing things along those lines. Your mindset has to be the change comes from inside, not from outside. But I can see a lot of people succeeding through Facebook dentistry, what are they doing, alter the same thing. Because a lot of people end up on courses, which are you know, I’m going on a course about smile design, or on going on a course that teaches me how to correct teeth, orthodontically and then put some composite bonding on and why are you doing that? Oh, because that’s what gets the cash in because the others are doing, that’s wrong. That’s wrong. So the first piece of mindset, so that the big, big investment has to be on mindset. And that comes from what you said, getting the right mentor and getting the right mentor. You know, your mentors are not just dentists to you who you can many people think a mentor is somebody I can go visit and somebody will visit be watching treatments. And no, [Jaz]No, no, a mentor can be someone you can follow as well you’ve never actually met that can still be a mentor, would you agree? [Dhru]Absolutely. And find the right mentors, but the strong investment is huge. Because when your mindset is correct, you know, that part’s gonna be hard, you get ready to invest. And, you know, I’m still paying off my mind some of my debts from years ago and whatever but and I did the MClinDent lucky the fees weren’t high, and I won’t lie. I got to a stage where I couldn’t invest in my education. So instead I invested in Tubules and got education through that [Jaz]You’ve not only got so much education, you’ve educated so many others. I’m so glad you took that so. [Dhru]It’s a win-win, but you’re then you invest in your education and you invest in the equipment, which will enhance your education, things like loupes, things like magnification, things like cameras, right? The interest because if you’re in the right mindset number one. Number two, you’ve invested in education. And number three, your investment in equipment like cameras will loop it back to the fact that hold on let me take a photo Let me have a look at the pictures of the work I did. How does it look who Oh, it looks great. It looks brilliant. Oh, this doesn’t look great. Suddenly you’re educating and the loop between investment in equipment and investment in education closes up a lot more. Do you see? That you then move on to the stage where you think you know what I will find a mentor and you know we have like Rob already and I often serve Email Rob and say just take this case. And Bob sort of replies back saying to your or not, but you get feedback. And it’s, that’s your mentor, because your mentor can now see the results of your investment. Because your education leads to you doing things which your equipment is capturing for you to get feedback from a mentor. But the last key and the last loop amongst this is the community you surround yourself with huge now you had Tubules directors, Tubules study clubs, whatever, you had a community. [Jaz]Aweome. Amazing people, I’m not going to begin to name any, because I know I’ll miss some people out but they’ll be the people who are part of the director group honestly have such a huge influence absolute privilege. I mean, I’m it’s gonna sound really weird, but I’m actually really privileged in the same whatsapp group. [Dhru]Exactly. But that’s a community. That’s what I mean. So you’re talking about two ends of the you talked about the fact of invest in education, invest in equipment, have a mentor, but on first side of that chain, is the fact that get the mindset correct. On the last side of that chain, is get the community correct, involved yourself and get connecting with the right people, there’s a standard saying, you are, you know, 95% of you is like the five people, you can, you know, surround yourself with most of the time some [Jaz]Yeah, you are the average of the five people you spend the most time with it for sure. And you can have that in professionally as well. So the five, you know, people that you five dentist or whoever you spend the most time or you speak the most with, you know, you’ll be the average of that. So you need to you know, if you’re stuck somewhere, you need to up your game, you need to be speaking to really passionate, empowering, clinically gifted people who can really you know, lift your game just by being around them and absorbing like a sponge, what they have to say. So that’s an awesome point. Anything want to add to that before we move to the next one? [Dhru]I think that’s, to me, the full key. So first thing is getting to a community. Second thing is get into the mindset, then start investing. I mean, I get so many young dentists will come to observe me and I say, yeah, that’s fine. And if you’re observing me, you’ll help me. Do you not use a camera. No. And I said, that’s the first thing you should have done, you should, you know, spend time, invest in an SLR and use it. So I will teach you how to use that first. So you know, it’s that sort of improvement, but they at least have the right mindset to contact me and say, probably come and watch your work. I don’t know how much they learn. You know, they’re better dentists out there than me. But if I can give them some sort of a boost of, you know, energy, I’m more than happy to make them, you know, inspired. That’s the right word, probably. [Jaz]And that will help them to make their portfolio and so on and so forth and up their game. So that’s awesome. All right. There’s the next thing is what, when is the best time? For something? I’m just asking this like a rhetorical question, we need to answer it. But you know, someone might say, Oh, am I ready? When is the best time? How many years after dental school? Should I go private? I mean, you give me your answer. I’ll tell you what I think. [Dhru]Personally, I think maybe between two and three years is a good time to be, three years perhaps is a decent time to try and think about the change. Now, the reason I say that is year one, invariably, you end up doing DFT most people do. There’s a handful of brave souls have send VTs and for me, and going down the extreme private, complete private route. And I think those are brave but good souls, because they immediately you see their mindset is completely focused on quality. [Jaz]I mean, that level of maturity. So you know, that’s a level of maturity, you know, they’ve they’ve got, they’ve made a bold decision, and they’ve stopped by and I think, you know, the most of the stories I’ve heard these people have, you know, been doing well, and you know, I’m really happy for them. But that might not be a reality for most people, certainly for me.Even after df one, I don’t think I was ready. I mean, I could I it’s about being sort of lucky, the jack of all trades, there’s no point in just being really awesome at composites, and then not being able to remove teeth, a atraumatically section elevating, you know, how your surgical skill, the sort of bread and butter needs to be good as well, before you can really be confident in private practice because I think patients can smell it, a patient can smell confidence, and the way you come across the way you speak. So if you’ve had lots of failures, right, then you know, you’re you’re going to be stronger and better for it. So sometimes, for me earlier on, I cultivated lots of failures. I don’t want to talk about the number of times a perforated holding endo and not on loads of endo and I do I still do loads of endo now. And I’ve learned so much from those past mistakes I made. So sometimes you need to be in a safe environment. And I’m not saying that you’re allowed to perforate in the NHS or allowed to perforate in the private because that’d be ridiculous. What I’m trying to say is that you need to be wherever you are sort of honing your skills and You’re going to be making mistakes, and you have to sort of be careful that you’re not biting off more than you can chew too early. [Dhru]I think you have to understand your limitations, you have to start simple. But you know, like I was saying, how Wendi go, the first year is DFT. The second year is always either you remain as an associate where you are or you may decide to go into secondary care to do DCT training, you know, and I encourage everyone to do DCT and especially as hospitals are bureaucratic and everything we said, but the level of experience I got doing maxfacts, restorative etc, was something I’ll never, never, ever regret. And it’s normally two or three years after, when you think you know what, ready to take that slow step. And the slow step comes, [Jaz]Dhru, I just say on that before you expand, because this is a really good point actually turned one young dentist listening thing about DCT. Not all posts are created equally. So speak to someone who’s on that post before, find out if you’re just going to be you know, just writing notes for someone or you know, you actually get to learn something. So it depends on who your consultants are. So not all posts are created equally. And then the second thing to bear in mind is do DCT because you want to learn in that way. Don’t do DCT because you want to avoid being in practice. That is a real reality. And I’ve heard it because I’ve been in two DCT posts, where people have openly said, you know, whatever I can do to avoid practice. That’s my goal. So this is why you know, don’t not please, don’t let that be your main motivator for doing DCT, you actually denying someone else position who really wanted to do it. [Dhru]I think look, it’s a matter of fact, right? As humans, there are two reasons we do something. One is we move away from pain. And the second is we go towards pleasure. And moving away from pain is what these people are doing. The problem with moving away from pain is you don’t know where you’re going. You don’t know what your goal is. But [Jaz]I really like how you described [Dhru]But it goes back to what we said initially about the chain mindset. If your mindset has changed correctly, you will be doing all these things for the correct reason. So the people whose mindset has changed, that was a one or two points before we were talking about it. That’s the time they will go into DCT because they’re doing DCT to move towards pleasure. And that pleasure is that I want to learn about dentistry. So your second points very important. But I’m going to also talk about that first point where you said, learn about the job you want. And sometimes you’ll be a pen pusher. I did work in a hospital where I could have been a pen pusher, and I want to do it a lot but even its pen pushing. It depends on how much you applied to yourself, right? And I learned a hell of a lot working in the consultants and registrar’s. So that’s the first thing. But the second thing is that, and this is what I tell all the young dentists around, go above and beyond please, I when I was a maxfacts as a CIO, for example, I found out a young, there was a consultant in one of the other hospitals who is doing extra lists on the weekend on Saturdays on Sundays, right? Who wakes up at silly hours of the morning on Sunday, but I decided to do and I’m going to go and help this consultant because I know even if it’s just watching, I’ll pick things up. At Sunday at 7am. I used to be there in the hospital. And finish, you know, one or two weeks I watched an observe. Then the third week when the consultant came in at eight o’clock and he said, should we do the consents? Then I said don’t worry, I’ve done them all, all sorted. You just see over them. And he was well, it was taken aback because there was initiative here. And it so happened slowly but surely this consultant gained confidence or trust in me, allowed me to do procedures and the GA. And at some point it’s a I’m running late do these cases. But it came to a point where he was so happy to let me just do it myself. And he said Dhru I’m going to put you on payroll here, please, because you’re spending too many Sundays here. And eventually I got a staff great job for a while. But the situation is you had to go on a Sunday at 7am. And most of the other people in [Jaz]This. That’s it you you made something amazing out of what could have been a really, you know, a pen pusher scenario for the rest of your career. So that hats off to you. And I’m going to give a similar story for what happened to me. So I was at a guy’s hospital. I was doing the Oral Surgery and restorative rotation, okay, Oral Surgery rotation, pretty awesome, pretty good. Some experience mostly, you know, mostly retracting, but I learned so much from them that I’m happy take out wisdom teeth surgically now. So, in the restorative bit, it was a bit quieter for a reason I won’t get into it. So I wasn’t doing as much. I could have just wasted our time away. But instead, I use that six months to write the paper in dental update for resin bonded bridges. And I got a publication out of it and I literally spent hours and hours and hours doing it. So even though I was presented with a lot of time where I wasn’t doing In the treatment, I’m going to, I use that, you know, time to gain these skills, I learned how to read papers, I got myself published in dental update, and that’s helped me and improve me as a clinician, like big time. So if you find yourself, you know, you’re stuck, or you are now in a DCT position, and it’s not going your way, you can make something out of it just like Dhru did, just like I did, I think anyone can, and should just take a few minutes to sit down. [Dhru]Exactly. Apply yourself think all these sort of things need to happen. And I mean, you know, it’s all about mindset and getting ready to take that challenge from that mindset. Now, this is what we ask people, this is what we say to people that don’t just, you know, don’t just follow the treadmill. And I think half the failures happening that or half the, you know, people who end up in the treadmill, I wouldn’t call them failures. But when I say failures, I mean, failure of growth happens in that respect, when you’re not [Jaz]stagnation [Dhru]Stagnation is probably the better word when you’re not thinking beyond the box, you’re not applying beyond the box. And you have to do that day in day out in whatever you do. I mean, I probably do less of that in dentistry at the moment, more of that in Tubules, perhaps. But I’m still doing it day in day out, I’m thinking where do I push the barriers, might see, you know, my team think I’m mad, but that’s an advice to everyone. And if you do that, you automatically find yourself growing. And if you automatically find yourself growing, you will just find that you want to then do things, which are higher quality, or better quality, whatever it is. And as a result, you find yourself, you know, delivering much higher patient care, which you know, I’m going to do this privately, and you have the confidence, you have the energy to do it. And when we’re talking about upskilling, don’t forget, upskilling isn’t just clinical dentistry. Upskilling is education skills and everything else that comes with it as well. [Jaz]One bit of advice, I just, you know, randomly read on Facebook, from, you know, sort of things that you just read, one of the comments is for every clinical course you do do a non clinical course. And I really like that philosophy, you know, I mean, not that I probably do as mean non clinical, as I do clinical, but it’s just, that’s how important non clinical is as well and to apply that. So as a very. Last thing, Dhru. One more thing to discuss now is there’s these salaried posts going around about 35k. You get some mentorship, you work about four days a week, one day you shadow, What’s your take on that? This is private practice. [Dhru]Yes, it is. And people have asked about it, etc. And like I said, I think, yeah, my take on those, it all depends on the practice and what you want to achieve at the end of the day. Some of them are very good practices, and for somebody to, you know, offer you that post and be a good mentor, I probably would jump at that opportunity. Because I think Dentists have to get ready for the fact if they’re not yet that, you know, salaries are not going to be high for a long time. And if you can get a mentor in a private practice at a certain PayScale, 35 K’s you know, it’s sensible money, just go for it, take it, because you’re not going to translate that [Jaz]Dhru 35k I just you know, that’s still a very decent money for someone who is quite new out of dental school. I mean, come on, guys. I mean, the last actually even compared that to the UK averages. It’s good. So I agree with you, I think it’s a good opportunity. It depends on the reason why that post has become available to if they’re posted become available, because someone thinks they want to give back to a young dentist and mentor them and hopefully grow them so that they can you know work and to the best potential within that practice for the future with a long term outlook then great, but if it’s out there, and you know, who knows how to gauges but if it’s if that posts only exists, because the principal wants to shaft their patients out who they can’t be be able to treat or low value patients so that you can just do some glorified hygiene therapy work, then that’s not on. So I think you’ve got to do a little bit of homework and stuff. [Dhru]I think again, you know, we we say glorified hygiene therapy work and this is not demeaning. Any hygienist therapist because they do a great job. I tell you something, and this is something I have realized as well, is that you know, even doing that sort of work, if in the right environment, your basic restorative skills can really shoot up and ultimately that’s the foundation for good dentistry. So if you’re doing you know, what do you call the hygiene work, suddenly your periodontal skills are shooting up. During the therapy work, your restorative skills are shooting up and I translate that to you get a good ability to build some solid core for future crowns, or you’ll have inability to build some solid skills in communication and basic periodontal treatment for patients in the future. So even those jobs can have their own advantages, saying that I’m obviously someone who finds silver lining in every running cloud. I, you know, I think there’s some serious benefit in that as well. The question is, what do you want to do? And what do you want out of your mentor, and what is your mentor achieve, and all of these sorts of things come around. And I think that’s the important bit here. You know, even if, if they were given basic basic work, they’re still, you know, you get three, four years out of dental school, that’s a job worth looking at. I mean, I worked at the middle of Wales, where I need nobody for three, you know, and I built a kind of a sort of life there. But I stayed in a practice where I could work six days a week, because I had nothing else to do, but had some good mentors and had some really good support. And it wasn’t NHS practice. It was a big NHS contract it was sort of that time before there’s fee for item and then uda, but we delivered some good quality care, and I learned some really good skills. In fact, that’s one of the things I’ll tell young dentists, if you’re not tied down by family, and other issues, you know, responsibilities moving out of the big cities into areas where, you know, dentistry is really needed by patients go and do a few years, you just don’t know. I mean, I spent three years in Welschbillig, one of the best memories of my time come from there. Now, at places like Lincoln, or certain outreaches of Scotland, dying for dentists, you know,so many practices looking for it. And those practice owners will appreciate you coming there. And so many of them will even spend extra time mentoring you. And you know, people are, my friends are in London, listen, your friends are always going to be in London. But if you’re really focused on building your career to a certain level, this is what we’ll do. So even if you’re being offered in the outreaches, 35k, with someone as a mentor, but great find out the mentor skills what education is a mentor? What are the mentors interest? Is their interests? [Jaz]values align with your values [Dhru]Absolutely. Do their values align? Do their interests align? And if you can do that, you know what? You it’s out jump, It’s such an opportunity. I mean, I can’t do and just, you know, I am, what makes me think is so many people want to stay back in or they want to stay where they grew up, or where they’re comfortable. Oh, no, but I know people around here. And I just think goes back to it, your best growth happens when you move away from your circle. And I think people need to do that. it’s obviously not easy, but it is easy, anybody could do it. So go for it get and that’s only by your do it, think out of the box, extremely, usually apply yourself. And maybe then you will find ways to develop yourself, grow yourself and find the right opportunities to build a happy, successful and satisfying career in dentistry. You know, that’s my viewpoint. Amazing. [Jaz]That’s amazing. And I want to finish it out. Because that’s such a powerful thing to end on. And I think you know, there’s a few little gems in there. But I think why like, the reason I am I’m so glad I chose you to speak about this topic. Because the extra dimension that you brought into this above and beyond what I sort of read out was the whole mindset philosophy. And I think that’s the take home message of this podcast, you can have the portfolio, you can invest in loupes, you can get invest in the camera, you can go on all the courses, you can do the whole curriculums out there, you can focus on making your communication amazing. Your portfolio will be vast and really diverse. But you really need to make sure that your mindset is in the right place. And that’s what I think I’ve learned today to pass on to everyone. So Dhru, thanks so much for speaking on Protrusive Dental podcast today. You were awesome. And I want to encourage everyone to become part of Dentinal Tubules. I mean, it’s tax deductible is so cheap. There’s hundreds of courses on there. What are you doing if you’re not on Tubules right now I mean, if you’re thinking of being in private practice, and you’re on Tubules, then I see those as antagonists. I mean, it just doesn’t make sense. [Dhru]No, it’s not. A lot of people think it’s CPD. Yes, you get CPD for it, but it’s education. And CPD is a bonus, but it’s about education and inspiring people to be the best that they can be everyday, you know in our group of people. Our dentists, our community, our members help each other because we want to help each other to do exactly what we said, Get into the inspired mindset. And if you’re in that mindset, my friend, nobody can stop you to believe and do the best you can be. Ultimately that’s what I believe. [Jaz]Awesome. Thanks so much, Dhru. [Dhru]Yeah, thank you. I appreciate you inviting me. Jaz’s Outro: Okay guys, I hope you enjoyed that session with Dhru. I think there’s loads of great tips inside there. If you enjoyed this podcast, please share it on Facebook or Instagram. Write me a review on iTunes or Stitcher or Google podcasts, wherever you listen to this today. I want to give a shout out to everyone working under the NHS actually, I think you guys do a fine fine job out there. Private dentistry is not all that is made out to be. It’s all about the mindset of the Principal mindset, the practice, and I hope you guys have success in finding the place that you really want to be at and you deserve to be. So thanks so much for listening. Catch in the next one. Thank you.

Have you ever thought of moving to the United States to practice Dentistry? Where do you begin? Join us for this podcast with Dr Jaz Gulati as he navigates through the experiences and journey of Dr Kristina Gauchan who is a UK Dental graduate and is on track to work in the USA. If you qualified with your primary Dental degree from anywhere outside of USA and Canada, you will need to follow the pathway Kristina shares in this episode. Some helpful resources that Dr Kristina has kindly shared as part of the Podcast notes: Tips for International Dental Students | ASDAMembership in ASDA. We encourage you to join ASDA to gain access to resources and education on the dental school application and licensure process.www.asdanet.org ADEA CAAPID DirectoryADEA CAAPID Directory ADEA CAAPID 2019 Application Cycle March 1, 2018 – February 22, 2019. Many U.S. and Canadian dental schools that offer advanced standing programs for international dental graduates participate in ADEA CAAPID.www.adea.org Licensure Information by State – ada.orgLicensure Information by State State Licensure Tables. The ADA attempts to keep this information current based on information from state dental boards, clinical testing agencies and state dental associations.www.ada.org Dr Kristina Gauchan graduated from the University of Liverpool in 2015. Having married an American resident, she has now entered a new chapter in her life. She is ready for the next academic venture as she will start her two year international dental program at Boston University in order to obtain a DDS/DMD to gain her US dental license.    Click below for full episode transcript: Jaz's Introduction: Hello everyone and welcome to episode 2, the protrusive dental podcast. Happy new year to you for listening to this. Jaz’s Introduction:Today is all about moving to the U S of A. Even if you’re not interested in moving to the USA, I think every one of us post qualifying from a UK or international dental school, has actually wondered, I wonder what it takes to move to the USA, because I think very early on, we pick up this knowledge that our dental degree is not actually valid in the USA. And there are many barriers to actually working there. So this podcast is for anyone who’s ever wondered what it takes to move to USA with your dental degree, how to obtain a license there, or perhaps you’re already midway through the process or very heavily invested or considering about moving to the USA. This will give you lots of good tips and experiences from our guest today, Kristina Gauchan, who, she’s done very well. She’s actually been starting at Boston university to convert her dental degree to a US one. And we’ll be talking all about entrance exams, fees. The politics of it, language exams that you have to do that, I didn’t really appreciate. So we’ll be hearing all about that today. Protrusive Dental PearlBefore we delve into that, I want to share with you the Protrusive Dental Pearl for today’s episode. Again, this is another nonclinical episode and do not worry. I’ve got lots of clinical stuff lined up for the future. But anyway, today’s Protrusive Dental Pearl, which is also nonclinical is a financial one. Basically, I want you to go to www.globalrichlist.net and I want you to enter your income. Okay, because this is something that is so eye opening. You need to see that if you’re listening to this podcast, you’re likely a dentist, therapist somewhere. And actually, when you enter your figures in, I bet you’ll be probably in the top 20 million people in the world. Okay. Top 20 million richest people are probably in the top 0.3 percent of people. And sometimes it’s really important to appreciate how lucky we are and how privileged we are to live in these countries that we live in. And to do the work that we do that is very stressful and it brings lots of reward in, which I think we’re very deserving of, but sometimes really, really important to know that we really are in the top 0. whatever percent in the world and to never forget that. Just looking ahead at future podcasts. I’ve got lined up. I’ve got stuff about clinical microscopes, how to make it affordable and practice. I’ve got specialization routes, emklin dense, becoming a registrar and let’s say restorative dentistry and all these routes that you tend to consider at any one stage of your professional career. So we’ll be delving deeper into that, a few occlusion topics lined up. So, I’ve got lots of great content coming. So please subscribe on either iTunes, Google podcasts. I’m now on Spotify as well. So share the love and I’ll look forward to connecting with you more. So let’s listen up to Kristina Gauchan interview with her, which I think is such a great resource for anyone who’s even vaguely thinking about moving to the USA. Enjoy. Main Episode:Yeah. Tell everyone who’s listening right now a little bit about yourself, where you qualified from, what you did after you qualified and how you ended up in the USA. [Kristina]Okay, sure. So my name is Kristina Gauchan. I graduated exactly three and a half years ago, 2015. Since then I have, I did my VT in Ipswich Deanery. So that’s Southeast of England. That’s where my family live. So yeah, that was the year flew by. And then after that I was an associate for about a year and a half. Before I decided that was it and I wanted to try and pursue my career in America. [Jaz]And for those of you who don’t know you, I mean, obviously you’ve married someone who’s from the US, right? So that’s obviously been your sort of background. And had it not been for that, you probably may not be in the USA right now, would you say? [Kristina]Exactly. No, that’s exactly it. I don’t think I would have, because obviously there’s quite a few hurdles to get through. We’ll get into that detail a bit more, but yeah, for me that he was the main thing, let’s say. [Jaz]Sure, sure. Well done to him. So he managed to kidnap you and take you to the USA and that is a super daunting for you, what were your thoughts when you, this is becoming a reality to you. You’re about to move to the USA. What were you thinking and how did you even start? Where does one begin? Where do you start? [Kristina]That’s the biggest question I think and that’s one of the hardest step, I would say, is actually deciding if this is it for you or not. Because obviously people research, people, read up about it, but really when they know it’s actually happening, I think that’s one of the biggest things to make that first step. So for me, for me and my husband, we wanted some country where it’s our careers are going to be progressive for both of us. Obviously, we’ve both studied, so we wanted something that’s good for bigger opportunities for both of us. [Jaz]And Sumit is non-medical, non-dental, is that right? [Kristina]Non dental, yes. He’s in software engineering, so, IT consultant, yeah. He makes softwares. I don’t know too much about that. [Jaz]That’s fine. The show is all about you, not him today, so it’s fine. [Kristina]Yeah, it’s awful. But- [Jaz]So you decided that it would work, but where does one start? Where do you even begin to find out more about it. And I suppose for a lot of people, it might be difficult. That’s why we’re bringing you on the show today so they can learn, how to go about it. So what is the first step, Kristina, to working with the BDS in the USA? [Kristina]So, I would say there’s a great Facebook group for a lot of pursuing international dentists because it, so no matter where you trained, it’s the same steps. So, for me, I researched online, there’s great websites, international dentists website to qualify and work in the U S. There’s lots of resources out there. So for me, I started reading up about that. I reached out to my friend’s family, whoever’s done the same. And I found that a few have done the same as me. Luckily, there was a girl just above me, in a dental school. And she actually literally, I think she’s even skipped her VT. And I remember that she was doing this. And for me, I was like, wow, that’s amazing. So, I asked her for everything. [Jaz]It’s so useful to have someone, right? Who’s, so you can follow in their footsteps, like almost like a mentor to you. [Kristina]Exactly. So she was really great. And I think I bought her my, but you need that because you read so much online as well. And you think, oh, I could actually, when it comes down to it, there’s actually a little thing that you find that, they are quite strict on, so you do need to really follow the guidelines and it’s hard, isn’t it? But luckily, I had her, I had a few other, my husband’s Sumit So friends had done the same thing. So they qualified in India and Nepal. So for me, it was the same route we take. So it doesn’t matter where you qualify anywhere out of the US or Canada. So you have to do this two to three years of extra training. It’s essentially going back to dental school, the last two years of dental school, let’s say. [Jaz]And how is it determined whether it’s two years or three years that you have to do? [Kristina]It just depends on the program. So there’s obviously 50 states. There’s lots of dental schools. Each one has different curriculums. And they all have different timelines as well. [Jaz]And how do you decide which one’s the right one for you? And how competitive are these places for internationals? [Kristina]Very competitive. I did a bit of research and on average it’s about 20 places maybe for about a thousand applicants and I know that sounds really crazy. [Jaz]Nationally? [Kristina]So internationally that’s for us. [Jaz]No, is it like in the whole of US only 20 per year? [Kristina]I think US is a bit easier because they have a lot bigger intakes. I’m talking about international program you see. So, there’s about 30 odd dental schools in the U. S. that accept international dentists as students. Does that make sense? [Jaz]Fine, so 30 dental schools that accept international students and how many would they each take on per year, roughly? I mean, do you know this? [Kristina]Yes, it’s from 5 and it can be up to 80. So it’s a big, big contract. So average, probably 20 to 25. [Jaz]Internationals? [Kristina]Just internationals. With the national, and what they do is they join you in with the nationals. Does that make sense? [Jaz]Yeah, yeah, yeah. [Kristina]You all go to third year together. And obviously the ratio is going to be high. It’s almost like graduates join second year. It’s just like that. [Jaz]Okay. And you had to go, well, before we come on to how you interviewed for all that, I want to know entrance exams. Okay. So how many exams are there? How difficult is this? Where can you get help? And how many sittings per year? All that sort of stuff. Tell us about the exams. [Kristina]Sure, sure. So initially the main hurdle is the National Board of Dental Exams. So there’s part one and part two. So part one is quite simple. Although it’s a little more sort of science based, it’s purely anatomy, biochemistry, microbiology, pathology and dental anatomy. So it’s an eight hour exam and you do get breaks. So this is just the beginning, remember you get breaks every hour, so it’s up to you. You can manage your time quite well, but yes, they give you enough time, multiple choice questions, and it’s 400 questions, so a hundred in each category. [Jaz]Okay. [Kristina]And you know what? It does sound a lot, but, and at first I was just dreading it, but you can do it. It just needs a maybe a few months of practice. So a lot of really, I think you do need to, people do it on top of their jobs. I know people who have done these exams with a full-time job, and I really praise them, with families and things like that. [Jaz]Hats off to them. Yeah. [Kristina]For me, yes. Hats off exactly. For me, I was really lucky, having a supporting husband. I took about six months out and I literally just moved there and I was stuck in my room and I just got on with it and that’s the only way I knew I could do it. [Jaz]Very good. And so that’s part one, is it? [Kristina]That’s part one, yes. [Jaz]And do you know roughly a couple of things about part one exams? What is the pass rate or failure rate, even that? And also what are the fees like? [Kristina]Yes. So fees, roughly all the exams about 500 dollars maybe a little bit more, 550. It goes up every year, I believe that’s dollars and obviously, the flights, things like that. So I guess you have to take that into account. But yes, it was about 500. Yeah. [Jaz]And the pass rate, what’s the pass rate? [Kristina]The pass rate, I would say it really depends because I don’t think there’s like I reckon there’s a different pass rate for dental school, dental students, national students, and international dentists, because we’re having to learn this on our own. Whereas what traditionally happens is then the U. S. students actually do this on their second year, this board of exams, part one. They’re obviously taught it, aren’t they? So it’s like, for us, it’s like doing it during our second year of dental school. So I feel like they’re obviously got a lot higher pass rate compared to the international dentists. [Jaz]And what is the pass rate? What is the pass mark? Like, 50 percent or? [Kristina]Usually you need about 75. They don’t give you a figure, but you need at least 60 percent or above. It is my it’s a weighting. So it really depends. [Jaz]Again, it’s a weighted exam. Okay. [Kristina]They don’t give you figures. So they literally just say pass or fail. Initially, they used to it was up. I heard out of 99 and you need about 75. But I think yeah, now it’s no figures to it. That’s why it’s quite difficult to gauge. [Jaz]I see. And where are the centres in which you sit? Is there one in every state or? [Kristina]Yes, one in every state. So yeah, but most, so you know where you do your driving exam and where you get your other license exams is somewhere like that. Yeah. [Jaz]Okay. So you’ve just passed part one. You did that’s really cool. And then how long do you have to wait until you can do part two and tell us about part two then? [Kristina]Yeah. Yeah. It takes about two to three weeks to get your results. So they want to know that you passed your part one first. So you obviously wait for that to apply for your part two exam. So yes, few weeks later, just book it straight away. So, you know and you can book it a few months in advance up to you. So part two is a lot easier. So it’s literally finals, finals BDS, literally easier. I think, I mean, the only extra subject is pharmacology. The rest is literally, we should know everything, just recap your finals. [Jaz]And how many hours is this and how many centres are there? Tell us about that. [Kristina]So the same centres this is a two day exam, one and a half day, let’s say. So it’s again an eight hour the first day. And then the next day- Yes, MCQs, all MCQs. So, in a way, it’s quite lengthy. [Jaz]Like, clinical, like about root canals, to restoration, crowns, everything. [Kristina]Restorative, perio paediatrics, ortho as well. Yeah, radiology, oral surgery, and oral pathology and pharmacology. That was, do you know what, again, it’s very doable. At first, I was really dreading this. But I did this within a month. Because I was in a tight time frame. I needed to- [Jaz]You had the pressure. [Kristina]I had the pressure, exactly. I had a holiday coming up, actually. [Jaz]Fair enough. [Kristina]And I was like, I don’t want to be doing this afterwards. So I literally did it like a few days before we left for our holidays. [Jaz]And this one is the same exam that the U. S. sort of dental students do as well, or not really? [Kristina]Yes, yes. So the dental students do this actually in their fourth year, so actually in the final year. So again, that’s why I could really relate to it being like the final BDS exam. So yeah, it is interesting. And it’s one and a half day. So the first day is like in 400 questions of MCQs. The second day is all scenario based. So it’s probably fewer questions, probably about 50, but there’s scenarios. So, you know they’ll give you a patient bio. They’ll give you the medical history. They’ll give you the symptoms. They’ll give you full mouth periapicals OPG as well. They’re very detailed. So, you’re not sort of stuck in any way you can. [Jaz]So it’s like an OSCE is it or? [Kristina]Yes, OSCE, that’s what I was looking for. [Jaz]Yeah, fine. So it’s an OSCE, but are you actually cutting any teeth? Are you actually showing your preps? [Kristina]There is no practical, it’s all on the computer. But it’s scenario-based questions. So you’ll be obviously asked some tricky questions, but it really is not. I think we overthink it, don’t we? We always just worry too much thinking, oh, they’re trying to trick us, but really they’re not. They just want to test your knowledge. And it’s funny cause like for me, then I realized that, actually teeth are teeth and people are people everywhere. It’s not that challenging at all. [Jaz]So compared to, obviously you qualify from Liverpool. We did the finals in a UK well respected UK dental school. How is the difficulty of the finals in UK compared to what you did in the US? [Kristina]So the part two exam, do you mean in relation? [Jaz]Yeah. I mean, was it similar to sort of what we would get here in the UK? [Kristina]Yes, yes, exactly. So that’s what I mean is, is you could probably even study just a few days for that exam, really like people who are on top of their knowledge, because if you’re practicing dentistry, I think these things come to you. They are quite obvious things. It’s just a few, like the nitty gritty, the figures and then the doses, things like that. You just have to brush up on, but it is definitely doable. [Jaz]Good. What I’m doing in my head while you’re telling me about the exams is I’m comparing the ORE sort of exams that we have in the UK compared to what you’ve just described. And the ORE, actually sounds much scarier and the pass rates are lower. And obviously you’re cutting teeth and you’re showing preps, but the difference is Kristina is obviously once you’ve done the exams. You still can’t practice, whereas ORE, once you’ve gone to part two, that you can start practicing in a way, right? So now, that leads us very nicely to the next bit. You’ve got your exams, and so you a- [Kristina] We also need to do TOEFL test, so the English exam. [Jaz]No way- [Kristina]You have to if you’re a UK citizen or not, they don’t care. [Jaz]This is ridiculous. You have a UK BDS and you have to sit an English exam. [Kristina]Yes, and that was actually quite tough for me because obviously I’m using my second language, isn’t it? [Jaz]Oh, interesting. [Kristina]So I was just laughing to myself, and my husband was laughing at me. He was like, you don’t need to study. And I was like, I probably should have studied. I mean, I got 85%, but really I want, I should have been getting 95. You want that top mark if you can. But I just thought- [Jaz]And what’s the pass mark? Just out of interest for anyone listening, what’s the pass mark? [Kristina]Well, there isn’t a pass fail in the TOEFL, so there’s like a grade, it’s a grading system. So, the higher you get, obviously, the better. So, it’s out of 120. Usually, dentists will want at least 95 to 100. So that’s probably about 80 percent that want, yeah, at least. It does depend but yeah. So, that’s a horrible exam. [Jaz]So, you got the language test out of the way. So, what’s next? [Kristina]The next is also we have to translate our qualifications. So, our transcripts so, on our fine graduation, they give us all these papers with our exam results from year one to year two BGS year five. Sorry. So they need that translated So there’s a there’s two main bodies that do this ECE Educational Credential Evaluators and WES and they they so you have to pay again. It’s all money, that’s another thing. It’s it’s quite a bit of investment initially later to get these- [Jaz]And how long does that take to get done? [Kristina]At least a month, I’d say, yeah, because they want it directly, sealed copy from your university. So you can imagine, I was calling up, Liverpool University, they’re like, oh, I need to send this here, then this, that. But they were, they were great though, really helpful. [Jaz]And how supportive were Liverpool Uni in helping you? [Kristina]They were great, actually, yeah, they’re good on email. They’re not the quickest so I know other schools, I think, are quicker, and it’s all online, electronic service now, whereas us. I graduated in 15, so I had to ask for a paper copy and they had to DHL or FedEx it to the office in, yeah, so that all just takes time and money and more, it’s chasing them up and making sure. That’s one criteria. Another is also in the application for dental schools, they’ll need about three letters of evaluation. So they like one to be from your dean and one to be from your tutor or a boss or anyone. So yeah, they’re the main things. [Jaz]Okay, brilliant. So now you’ve got all that, are you still, are you ready yet to apply? [Kristina]Yes, yes. Just about. [Jaz]That’s a lot of hurdles. Okay. But this is the meaty thing now. So you’re going to apply. Tell us about this crazy application procedure now. [Kristina]Yeah. So, like I said, we’re a little limited, so about 30 schools you can choose from. And the good thing is you can apply to as many as you can, but obviously each application costs you at least 300, let’s say. Yeah. So it’s not free. It’s not like UCAS. That’s a shame. Luckily, we can apply to as many as we want. So the more you apply, the more chances you’ve got getting in. [Jaz]And like with the uni, is there a specific, like, for example, back in UCAS days, we had to apply between this month and that month. Is it similar? Like every year? [Kristina]Yeah, yeah. So each time of the deadline, absolutely. Yeah. So they start from March every year. Some schools are different, but usually the deadlines are by the summer. So July, August, the majority of the deadlines close. So you’ve got that three to four month period. That doesn’t mean that you have to apply within those dates. There are other schools that apply a bit that open a bit later as well. But the bulk of them you know, at least 70 percent of the schools have these the spring term, let’s say spring to summer. [Jaz]Then how long do they take to get back to you? And then when would you start the dental school? Let’s call it the dental school. [Kristina]So you have to obviously apply the year before. So say it’s the 19, it’s the 20 cycle you wanna apply for. You have to apply this year. Does that make sense? [Jaz]Yeah. So you would’ve applied last March, right? [Kristina]Yeah, March to June I applied. [Jaz]And when would you start? [Kristina]The interviews are a few months later. If then obviously if they like you, and then I start in July. So it’s quite a late start date. It’s one of the latest. [Jaz]So you’re going to start in July, 2019. [Kristina]Yes. Yes. [Jaz]Okay. [Kristina]And hopefully finish 21. But other schools started in January. So luckily, I got the program that’s two years. But that doesn’t, I don’t know if that’s lucky actually, because I think it’s really jam packed. They said you don’t even get a break. I think you, it’s a six day uni day. It is late, late days, late nights, and only two weeks for Christmas off. And in the summer, they can’t promise a holiday. I was like, oh no. Yeah. [Jaz]You know, that’s very typical of the U. S. U. S. is a country where a lot of people are very hard, yes, very hard working. The average person I hear in the U. S. gets 15 days of annual leave. [Kristina]Yep, yep, two weeks, exactly, two weeks. [Jaz]Yeah, compared to, about 28 that we get here on average. So, that says, that speaks volumes. So, well done for, for getting the place. Which uni is this, sorry, that you got it? [Kristina]Boston University, yeah, BU. Boston. [Jaz]That’s amazing. That’s a really highly regarded dental school. [Kristina]Yes. I mean, I, for me, I really just wanted to get anywhere because I just wanted to start, you know, it’s all I was just getting really impatient. But I was very lucky. Yes. Yes. And they were great. They’re lovely. Do you, there’s a few other things. So with the criteria, obviously each school has specific criteria is what they prefer, their requirements. Other than the National Board of Exams TOEFL they also sometimes prioritize permanent residents. It doesn’t mean you have to be though. So, people with green card or, so again, that’s something to consider, but you most do, cause it was internationally if they have the program most accept visas, student visas. [Jaz]So sure. Sure. Yeah. Is that what you have? You have a student visa or? [Kristina]Lucky. I have a green card, so I’ve obviously got it from my husband. So I was quite lucky in that regard as well. Also, another thing. So with the interviews and bench tests, have you heard about bench test? [Jaz]Nope. [Kristina]So, you mentioned the cut teeth. You also, some schools want that as well. So say out of 700 that apply, they interview, let’s say on average 150. And each one obviously has a- so I had about two-to-three-day interview for some of mine. [Jaz]Wait, wait, so you went to some interviews that were two to three days long? [Kristina]Two to three days, yes, yes, oh yes. [Jaz]Okay, and then that’s where you were like cutting teeth, and I mean just tell us a bit, give us a flavour of three days, how would, what on earth are they doing with you for three days in an interview? [Kristina]Yes. I know, I know. So it was the first morning is the intro. They give you a little info about their school. They’ll introduce each other, the faculty members and you get a chance to just speak to the other let’s say, candidates as well. They’ll have lunch for you. And then in the afternoon they’ll have either a written exam or a face-to-face interview. So, like face to face with a panel. [Jaz]Sure. [Kristina]Or on one so with one of their members so that they’ll alternate days. So obviously half of you will have it on the first morning afternoon and second half would be in the second morning. Let’s say and- [Jaz]Are these tough interviews or are they just checking your human side? [Kristina]No, very casual. So they’re very nice that they’ll just want to know about you well, you know why this school, same thing interview as well my dentistry why you know our union interviews. So very very funny. Actually, I think they’re more friendly It’s more of a chat actually, so the Americans are quite casual people. So, yeah, it wasn’t nerve wracking at all, actually, after my first, I was like, oh, this is breeze. I kind of felt like, oh, I want them to ask me something a bit more challenging or, you know. But really, it’s just a chat and they just want to know, you know if you’ll be a fit for the school, I guess, yeah. [Jaz]Okay, and then on the third day, what would you do? [Kristina]The third day is the cutting the teeth. So, usually they don’t tell you in advance. They’ll give you a little practice session. So, luckily, we were lucky to give you a practice. So, our OSS, so, our phantom head? The teeth on the heads, yep. So, it’s just like that. You have to cut. Either a premolar or molar, and it’s usually a class two cavity design. So you’re in the box slot. Either that or they’ll want a crown prep or they’ll want both, two to three procedures they’ll want you to carry out. Okay. Some will give you a, a rough measurement indication. So let’s say, you know, two mill depth for the crowns, let’s say MCC prep or a gold crown, that they will give you the measurements, but some won’t. So you need to go by. That what that school follows, what traditional ways or some they prefer the less sort of more conservative routes. So, yeah, it is- [Jaz]A bit of a guesswork involved there, I suppose. Fine. Interesting. And so once you’ve done your sort of interviews, my quick maths tells me that if there’s a hundred people there and they only take on twenty, only one in five people will get accepted. [Kristina]It is quite tough. Yeah, it is quite tough. [Jaz]So well done once again, honestly, that’s really, really cool. Tell us about scholarships and fees. [Kristina]Yeah, so, I’m not too sure about scholarships. I think you can apply. So luckily, another lucky thing is that if you are a resident or you’ve got some links there, you can apply for government loans. So they’re interest free loans until you finish. So we’re quite lucky in that regard. Otherwise it’s private loans. On average, it’s about, I’d say a year, but the to adjust tuition fee is about at least 80, 000 dollars, US dollars. So that’s not taking into account other things, your accommodation. [Jaz]Accommodation and stuff like that. [Kristina]Yeah. Tuition is obviously the main thing and that’s about at least 80, 000. [Jaz]So you’re looking at 80, 000 per year? [Kristina]Yeah, and a lot of programs are actually two and a half years, so obviously that can build up a bit more as well. [Jaz]And on top of that, you need to budget for accommodation and then also like maybe, I don’t know, facebow, books, that sort of stuff? [Kristina]Yeah, exactly. Yep. Loops, they are very keen. Which is what you want, I think, if you want to be a good practitioner and a lot of us do, I think it’s nice to have that mindset already, that they’re very they’ll apparently, I have a friend who’s doing periodontics in California and he said, every night you have to read these articles that’s just the basic stuff. Yeah. They’re just a bunch of things that you have to get through and they are very, very- [Jaz]Hardcore, hardcore. [Kristina]Yeah, hardcore, exactly. [Jaz]Brilliant. And once you, fingers crossed, once you graduate from BU like ORE, you can, if you want to work in the NHS, you have to get equivalents, whatever. I mean, roughly describe once you come out of dental school, I mean, do you have, is there another requirement you have to meet after that? [Kristina]Yes, unfortunately. Hopefully the last one. Yeah, it’s just the licensing is again, it depends which state. So each state does have a specific regulation, but a lot of them, they do overlap. So there’s a certain license. If you get that, you can work in quite a few states. But yeah, you have to check with each license. And again, I can give you these links. [Jaz]Sure. So, it’s called licensing. [Kristina]Licensing exam. Yes. Licensing exam. Yeah. Okay. And they were quite simple. Literally I think an hour exam. And it’s just like your finals, isn’t it? So it’s just questions. [Jaz]And then again, do you have to do a licensing exam for each state or one license might cover some states, like I said. [Kristina]Yeah, there is a one license that covers quite a few states, but if each specific one will follow different ones so that, it really depends. So I can’t say for sure, but let’s say there’s about five licensing exams. Right? So, if you do obviously all of them, then you’re good to work anywhere, but if you know where you’re going. [Jaz]Yeah, you’d have a rough idea of where you want. [Kristina]You would, yeah, yeah. And usually you can get away with just that licensing exam. Yeah, and I’ve heard that they’re quite easy. They might, some might want you to do a quick little practical, so even bring a live patient. But that’s quite rare, I think. Okay. Yeah. [Jaz]So then finally, you can practice as a dentist in the U. S. [Kristina]I know, I know. It sounds like a lot, but like if you’re dedicated and you’re willing to really put the work in and the time, it’s the time it’s doable. For me, I thought, Oh, I can’t do it. I can’t do it. I was very negative at the beginning because I think it is daunting. Like you said, you see all these things you have to do and it’s not a quick thing. It’s not, you know, you can’t just take this exam. [Jaz]You have to do it wholeheartedly. Don’t you? [Kristina]Exactly. So but it’s definitely doable. So I want to really encourage people, who are thinking about it to go for it. And also another encouragement is they do like that you’re from UK. So a few interviews, so I applied to about 10 schools. I got interviews from at least four. The others are, they’re still the deadline hasn’t closed yet. So and I went to about, I think I went to three interviews. Yeah. And a lot of them were really, amazed to see you because they’re like, Oh, you know, what brings you over there, over here. Cause they, they love England. And they, so they love the accent. They can hear it. You know, where are you from? And then, and then they’re lovely. [Jaz]Very good. And when you went to these interviews, just out of curiosity of the hundred or so people that are being interviewed can you, like, is it like 50 percent from India or like, you know? [Kristina]Yes. So Indians are literally, I’d say 90%. [Jaz]Wow. [Kristina]It’s quite funny actually. Yeah. But yeah. And, and actually for them it’s a little harder. So I believe that they want a higher GPA. They call it GPA. [Jaz]Grade point average, isn’t it? [Kristina]Yes. Yes. They want a higher GPA for them. They want higher top up for them because it’s competition. They like to have ethnic diversity in a lot of these schools. So they can’t take just all Indian people. So that’s why it’s a little tougher for them, actually. Yeah. [Jaz]Interesting. So those listening who are from the UK got a BDS, you might stand a good chance. [Kristina]Yeah. Cause on the application, on the online application, it’s sort of like the UK portal. They ask if you, you know, got what are the qualifications, if you’ve had masters and a lot of the students do. So sometimes you’re getting, you know, periodontics and, you know, specialists apply as well. For me, I felt a bit like, oh gosh, I’m not thinking back to them, but. They treat you as the same and some schools will value them. So, so I know California schools are really tough. So, California, New York, all these, you know big cities that they want you to have an extra specialty or things like that, but that I shouldn’t let you down, you need to go for and apply if you do want some might want, you know, like the last year or achievements you’ve got. So, all these things, all these extracurricular things, it is definitely worth adding to your CV so you can add all these things. Yeah. [Jaz]Okay. Well, one question I’ve just thought of based on what you’ve said, that is imagine you’re an orthodontist in the UK and you go to the States. Would you have to do everything that you’ve been described and then specialize in orthodontics in the US or? [Kristina]I think so. Yeah from what I’ve understood. Yes. Sometimes I have had a few things, but obviously I wouldn’t want to give a total answer. But sometimes you can just do the specialty program. So usually it’s about three years, isn’t it? So let’s say you go to do the ortho there that yeah you could do your part one and part two exam and then if you work in that state for at least five years. I’d Believe you can qualify, do a general dentist, but usually yeah, you, you can either do one or the other. You have, otherwise you have to do this BDS if you wanna practice as a general dentist and a specialist. Does that make sense? [Jaz]Yeah. Yeah. Yeah. Well, that’s interesting. [Kristina]So yeah, you can’t dibble, dabble. You need to. Do so they are quite tough on that actually. Yeah. [Jaz]Cool. And one more question I had is, do you know anything about general dentistry in the USA in the sense that, in the UK, most dentists work for the national health system and you’ve got UDAs and stuff. From speaking to my American colleagues, they’ve got a lot of insurance based practices there. So a lot of what they do, is similar sort of restrictions that they have. It’s just a different name for it. Can you just, do you know anything about that? [Kristina]So like Medicaid things like that, which is their NHS service, isn’t it? So yeah, yeah No, no, I do know a little bit again. It’s more the rules and regulations like you said here because you know, we are so heavily NHS based and it is completely different there. It is heavily private. So they have insurance, but the government also- [Jaz]Has a fee per item, but there’s insurance basically, right? [Kristina]Yes, yes, insurance basically, exactly. But they do also, there are practices that do, you know, low-income support families, things like that, where the government pays for part of it, quite a big chunk of it. But I know that the pay there is a lot better than the NHS here, let’s say, yeah. [Jaz]Okay, very good. Well, that’s another potential- [Kristina]Yes, topic. [Jaz]A plus point on its own. Do you have any words of advice, tips, anything else you want to, anything you think will help any listeners out there who are considering the move. Tell me about the curriculum. [Kristina]My curriculum, actually, I’m really lucky. We do a lot of digital dentistry, so a lot of CEREC, so we’ll be doing CEREC straight away instead of the traditional crown, things like that. [Jaz]So you start Cerex from the beginning? [Kristina]Curriculum, yeah. Undergrad and even implant. I’ll be able to restore an implant. Restore is basic, but even in place. So, that’s quite interesting, isn’t it? [Jaz]So in your program you get to place implants? [Kristina]Yes, yes. And in most programs, you’ll be able to definitely restore implants at least. So, yeah. [Jaz]Well, Kristina, I think I’m really excited for the opportunity that you have. Even once upon a time, I was looking at MSC programs and perioplastic programs in the USA and life got in the way and I’m now sort of settled in London, but, I’m really excited for the opportunity that you have. You’re going to be taught by world class tutors in an amazing establishment. So go for it, really kill it out there. I hope you get all the success that you deserve. And thank you so much for helping. [Kristina]No, thank you for reaching out to me. Honestly, it’s been a great pleasure and I hope I’ve explained a few things. But there was a lot of detail I could go into, but. [Jaz]Of course, but yeah, as a sort of giving a bit of a guide, a bit of a flavor of what to expect. ’cause some people have literally no idea. Absolutely. This is gonna really help a lot of people. So thank you so much. [Kristina]Wonderful. Thank you. Jaz’s Outro:So there we have it. Thank you so much, Christina, for joining us today. I hope that’s been useful for all those listening today. As always, the show notes will be on the website, www.jazz.dental. So if you log on there, click on the episode, you’ll see you’ll be able to download a PDF of all the sort of useful resources that Kristina has prepared for you. So I’ll catch you on episode three, probably in a few weeks time. Thank you so much for listening.

A podcast interview with Surinder Arora (@DrSurinderArora) Dr Surinder Arora qualified from the School of Clinical Dentistry, Sheffield in 2011 and has been practicing Privately in Singapore since 2014 Need to Read it? Check out the Full Episode Transcript below! Why should you move to Singapore if you are a Dentist? This should really be a personal choice – only you can determine and discover your WHY.It is important to consider how this affects your children/spouse/partner/family and business commitments. Why Singapore? Singapore is Asia Lite. It is a Metropolis. Dental standards are high, and the weather is 30C every day! I cover lots more of this in my article about returning from Singapore and my experiences. What was it like finding a job then, and is it any different now? It is much more difficult now compared to 2-3 years ago. This is because the Corporates are less likely to hire foreign graduates because you first need to be on Conditional Registration with the Singapore Dental Council (SDC). This is not really a big deal, except you need to be assigned 2 supervisors, and it is due to a lack of supervisors that can be troublesome. Only once you have had 2-3 successful years, under the eyes of a ‘Supervisor’, can you then work ‘solo’ with Full Registration. First, you need to find a corporate or a Dental practice that is willing to take you on and they will help you with your application to the SDC. Where can I look for an associate position? The Singapore Dental Association classifieds is your best bet! What can Overseas Dentists expect in terms of salary Expect anywhere between 35 – 55% remuneration. Average GDP can make $6 – 20 K SGD per month, net. A lot of practices/corporates will put a safety net for you in your first 6 months so you can get a ‘base’ minimum salary e.g. $7K per month. Bare in mind, however, that Tax is pretty damn low! What is Dentistry like in SG? High standard – but varies massively depending on where you are practicing. Even in this tiny island-country, the demographics of just a few miles are massive and will influence if you are busy or not. When I was there, I was doing very run-of-the-mill family Dentistry, perio, extractions and Dentures! Words of caution to UK/US Grads looking to work in Singapore? Although you do not need to sit any exams to work in Singapore, it has become very difficult to find a Job as a foreign graduate. Should you continue to pay GDC subscription? Short term answer: Yes, to avoid the hassle Long term answer: eventually, after working for few years in Singapore, you may wish to stop paying GDC subscription. Surinder emailed the GDC and as long as you keep all your documentation and evidence of CPD, theoretically it should take 10-15 days to get back on the register. Found this useful? Subscribe on Google Podcasts and Apple Podcasts and Like us on Facebook! Click below for full episode transcript: Opening Snippet: Welcome to the Protrusive Dental podcast the forward thinking podcast for dental Professionals. Join us as we discuss hot topics in dentistry, clinical tips, continuing education and adding value to your life and career with your host, Jaz Gulati... Jaz’s Introduction: Hello everyone and welcome to the protrusive Dental podcast. I’m your host Jaz Gulati. Thank you so much for joining me, I hope this podcast adds value to your life. And I hope it gives you an insight into lots of things I’ll be discussing throughout the year, starting off with today’s show about moving abroad, specifically to Singapore because that’s where me and my wife used to live in work 15 months before we came back to UK and I want to share that journey with you all. Give you guys insight into what that was like, what’s involved in actually working abroad. The main reason for covering this topic as my first podcast is because on a weekly basis, I get asked questions from people all over the internet who, who find me on Facebook or Dentinal Tubules or wherever. And they noticed that I’ve lived and worked in Singapore. And they want to know how that happened, what that was like, because they are also considering to move. And I think to make this podcast available to them and share my thoughts out loud for as a reference to them will really help people when making that sort of career decision. And I’ve also got something lined up for Australia and the USA as well. So watch your space on the over the next few episodes. So today is all about Singapore. I’ve got joining me today Surinder Arora, who is very good friend of mine, she really is an amazing soul. I see her as if she’s a big sister figure to me. She’s the one who really helped me when I was moving to Singapore, we went to same dental school together, she was a few years above me. And she really has been a beacon of hope. And that’s just sort of the sort of person that she is she’s such a positive, lovely, bubbly person. And you’ll get to get you’ll get a flavor of that when you listen to her speak today. So I’m really excited to have her on the show today, she’ll give you lots of great tips about moving to Singapore, what’s it like to live in Asia? And what to expect when you’re working there. The sorts of questions that we’ll be covering today is what it takes to start working in Singapore how to start looking for a job. The common questions I get all the time such as, what’s the income like? What is the lifestyle like? Should you still be paying your GDC subscription when you’re there? What are the barriers to getting something called full registration. So we’ll touch upon that as well. And what I’ll do at the end of the show, and on my website, that’s www.jaz.dental on my blog to actually put the show notes, like a written summary in case you have time to listen to podcast. So you got like a cheat sheet of all the things that we discuss as a reference as a PDF download, and that’ll be available as well at the end of the show, we will see that down below somewhere. Another thing I hope to incorporate in the Protrusive Dental podcast is every time I do a show, I’m going to give you a tip, a pearl, let’s call it I’m recording the Protrusive Dental Pearl. And today is a non clinical episode and therefore I’m sharing a non clinical piece of advice with you. The piece of advice I want to share with you for today’s episode is to know and not to do is not to know. Okay, so I’ll say it again to know and not to do is not to know. So for me, the reason I’m saying this piece of advice that got me to kick into gear and actually make this podcast. I’ve known how to make a podcast, I known that I’ve wanted to make this podcast, but due to all any sort of excuse that you can think of “Oh, I don’t have the time or the resources, whatever,” you know, that voice inside my head was eating at me and finally I gave in and as I know I have to do this now, start this. I wanted to share my vision, share my passion for dentistry with people and podcasts are a great thing to listen to nowadays. And people are out and out and about on their commute. This is an output for my creative side. So it’s the same in sort of clinical dentistry or in any aspect of life. If you know something that you know, you should be doing something or you know, you’ve wanted to do something for a while until you take action is as good as not knowing at all so you have to take action. So my tip for you is whatever it is out there for 2019 that you know you should be doing and you’re not doing it the moment, go out and do it for me. I’m creating the protrusive Dental podcast. I’ll be doing lots more episodes and I hope you’ll join me throughout the journey. So that’s my Protrusive Dental pearl for you. Okay, so now it’s time to join Surinder on the interview. I hope you enjoy listening to this as much as I enjoyed recording it. Main Interview: [Jaz] So firstly, Surinder, thank you so much for joining us from Singapore. I know that you’re super busy lady and you were just in Australia and you sort of just your flight landed yesterday last night. [Surinder]This morning. Yeah. [Jaz]So those of you who don’t know Surinder Arora, she qualified from Sheffield in 2011. But the previous, he worked a few hospital jobs and practice jobs. It was in London? [Surinder]Yeah, London down in London. Yeah. [Jaz]Then you move to Singapore and that’s the main focus of today’s shows about you know what led to your move to Singapore, the circumstances, your stage in your career, which was quite similar to when I when I moved as well, but a few interesting things about you Surinder is that you’ve got your certified health coach. Which is awesome. It’s very, very unique. And you’re currently studying a Master’s in Public Health. [Surinder]I am, yeah. It’s a KCL. So it’s King’s College London distance learning. So I did look at doing it in Singapore, but then decided for the flexibility purpose to go to London. So yeah, it’s awesome. I’m really enjoying it. [Jaz]Brilliant. Brilliant. That’s it. I think that will be a whole new show on its own. But for now. Okay. So Surinder, described the stage of your career that you were at when you decided to move to Singapore. But I think your story is a little bit unique in the sense that it wasn’t initially Singapore was it was at Hong Kong Initially? [Surinder]It was actually Australia initially. So as an undergrad, like to simulate yourself, you can do like this kind of working abroad experience. But from quite early on time, I thought, you know, I’d really like to work in Australia, you have DB dental, you have other companies around and they’re encouraging, you can work in these places. So it was definitely on the card. So initially, I planned yet Australia one year amazing. And then it kind of shifted a little bit. I went to Australia for a few weeks. And I thought, you know, it’s a little bit far away from home here, actually. Then I started to explore other options. And my partner and I actually, we had a list of countries that we could both work in. [Jaz]Just tell us about partner, what you know, what he does, and how that worked out in terms of the move being possible. [Surinder]Yeah, so he’s in banking and finance. So it was kind of like marrying the kind of healthcare profession without kind of element as well. So we were looking at kind of big hubs and big cities mainly. So Hong Kong was on there, Singapore was on there, the Philippines was even on there. Wow, Australia was even an option. So I started to have a little look around. And to be completely honest, I’d never been to Asia before in my life. I literally Googled jobs in Singapore, I was working my way through the latest right? So I Googled jobs in Singapore, and I applied to three companies. [Jaz]Sorry, yeah. And when you Google, that was the exact situation I was in as well. When you type in a UK dentist in Singapore or UK, there’s nothing really useful out there. [Surinder]No, there’s not. So I just kind of went straight into jobs available in Singapore. There’s actually the Singapore Dental Association job list, which I found later on after I’d applied, but a few companies came up and I applied to three of them. One of them got back to me really, really quickly, like surprisingly quickly, and then before you knew it, I had a Skype interview at some ridiculous hour in the morning because I got the time wrong. And then I got offered a job as a dentist. [Jaz]Where were when you had that? You were in England when you had the Skype interview? [Surinder]I was in London. [Jaz]You were not working? You were not working as a dentist in England up at that point or [Surinder]So what I did so after my dental foundation year, I went into hospital as you know, all surgeries in London hospitals came out of that and you know, just it I really struggled to get a job in London. I had my CV was literally everywhere. It was over the BDA it was amongst the private clinics. It was amongst NHS, I was really struggling. I got a job offer in northwest London that night. Yes, come on jackpot. So I went to Australia came back. I worked there for a day and the second day I went in the practice, owner said to me “Look, Surinder, we’ve decided that you’re not right for the role, we want with more experience. We’re going to ask you to leave” and I was like, “What, it’s like, I’ve been here a day. [Jaz]That was so cold. [Surinder]It’s cold, but it happens. And you know, for young dentists, this is the kind of climate when UDA values driven down to the ground a lot of competition, particularly in the London area. [Jaz]This is why I’m getting a lot more messages. I’m sure you do as well, but this is why I’m getting a lot of young dentists and there’s basically two groups people who are messaging me who want to know about moving abroad to Singapore. One is those who are out of df one or just finished their a few hospital jobs and then now they’re like, okay, now what? And the other group is actually, 10, 15 years qualified and now they’ve got children, whatnot. And they’re so these are two groups. We were in that first group and you’re describing harsh reality. [Surinder]Yeah, it absolutely is. And even as I was doing my hospital job, I was working alternate weekends in private practice, just keeping my hand on the clinical ground, but it really had no waiting it really didn’t at all. So then from there, I do some low coming in a corporate in the UK, which was a massive eye opener. I don’t know if any of you listening or have ever worked for corporate but it is something really different particularly going from hospital into that kind of setting and I actually learned a lot but I also learned a lot of dentistry, NHS. The old expression bashing the Nash? Yeah, absolutely. It was, that’s the game, that’s what’s going on there. Then after that it was time, I was like, I wanted to do this year abroad, I’m going to do it. Singapore came about and literally, I moved out like first time in Asia, set foot in Asia 2014, I think it was October, November 2014. I started working in December in Singapore. It was quick, the process was really quick. So I mean, it took about six weeks, six to eight weeks for everything to go through. [Jaz]So let’s help everyone out in terms of infrastructure. So you had a skype group. So you went on the SDA website, you found the job board, you contacted three corporate, one of them got back to you really quick, you had a Skype interview. And then what happens in between you and actually you actually working in Singapore, just briefly describe the hurdles, one has to go through if you want to work in Singapore. [Surinder]Right. So roughly, this is what happens and things may have changed a little bit. So you have to come to Singapore, first of all, sign the contract, that’s the first thing that you do. And then there are some appointments. So the Ministry of Health is one of them, you have to go to the Ministry of Health, get your photo taken and show that you’re a true person to kind of get registered, the company that you generally work for then applies for your employment pass. So that’s kind of like them sponsoring you so to speak. So they apply for that on your behalf, that’s going on in the background, then you just have to have your medical checks done and some kind of the National Environmental agency, that’s another another kind of application you have to do to take radiographs. That’s something else you need to do before you start practicing. But there’s a waiting time. So it’s kind of like I think it was about six weeks, it can be shorter. And they need to see you in between as well. [Jaz]It can be longer as well. I mean, I’m sure you know, we’ve got friends out there who for whatever reason took a long time. I think if you were to give a guideline for someone moving out there to expect to have enough savings to cover yourself. I mean, would you say three to six months maybe just to be on the safe side? Or? [Surinder]I’d probably say now. Absolutely. Yeah, give it I’d say a couple of months minimum, what I did was I came here signed a contract. And I traveled around Asia for a bit, which is quite common a lot of people did that a time. Yeah, absolutely. Lovely, definitely recommended. We did a bit of traveling, came back and then you kind of have to be on the ground a little bit, because you have to have several checks, you have to go to the Singapore dental council that might have changed now. I had to go there physically in person. Yeah, Singapore Dental Association, your DPL and other memberships, those kind of things as well as they’re there at the tail end. But the main thing is signing the contract, going to Ministry of Health and then going forward in that direction. [Jaz]So the take home message number one, I think for this podcast so far is that before you go out there, or even if you’re you know, thinking about it, you need a job first, you need a ‘In-principle approval’, I think it was called. That’s right. And so you need to actually secure a job ideally, that’s what’s going to really accelerate your starting because if you just go out there without a job, which some of my friends have, it took them six to eight months, because they first find a job and then the rest of it can be quite quick. But the most difficult thing I think is to actually find that job. I know it’s easy for you. And actually, for me who followed in your footsteps, upon your advice working for the same corporate, which is called Q and M, we can we can discuss that a bit bit more later. But I think nowadays what we’re gonna focus a little bit on that later. But it’s it has changed a bit. And we can give some advice based on that. But the take home message is you need to find someone who’s willing to take you on first. [Surinder]Absolutely. I completely agree with that, Jaz. I know people that have come out here, and they’ve really struggled and there’s also the financial aspects as well. And if it when you were a little bit younger, I mean, I didn’t really look at this in too much detail. But you need to have your finances a little bit in place, particularly if you’re going to sustain yourself for a few months. So having a job. The good thing is everything’s online. So you can get information online quite easily now with the job list. And you can contact people, the only thing that I would say is when I got here, I found it easier meeting other people in different corporates, and different with different job opportunities in different offers. So I think there is something to be said for being on the ground. It just depends how you work and how you want to roll with it. [Jaz]Yep. And I think the other thing is just to anyone who’s thinking of moving out to Asia or Singapore, and you’re doing all this sort of emailing to and fro remotely. It’s a good idea to actually visit the country right and actually get it you know, there are plenty of things which might shock you like English is the main language, a lot of people say “How was the language barrier?” You know, it’s really humid. When I started this call with you, I was like, is it raining and you’re like, “No, it’s the fan”. It was one of those things that you actually get a feel, is this country right for you? And if you’ve got children into learn about the education, lifestyle, expenses, so why don’t we just dealt right in so when you when you start working the number one question I get, believe it or not, I suppose it’s really important is what’s the income like? [Surinder]Oh, yeah, this is the question that everybody asks and you know, we have a lot of thing, but “Oh, shall we ask, shall we?” Really important, it has to be known, it has to be discussed, there’s a massive range. And it really does depend as you’ve experienced, where you’re working, the amount of patients that you’re seeing, the type of company that you’re working for if you are working for a company. And I would say that in seeing dollars, anywhere between six to 20k a month. [Jaz]I think that’s a really good range is a huge [Surinder]That’s a massive range. And it can be even more if you carry out complex treatment. Your fee split with a company can be between 35 to 55%. That’s also something to consider. Yeah, there’s a massive range there. [Jaz]So Surinder, I mean I was on when I was with the corporate I was on 45%. And you know, to get 45% here in private practice is really a thing of the past, you wouldn’t get that. And the other beneficial thing about Singapore is the tax is so low. [Surinder]So low 15% max like you’re looking low. [Jaz]Max, I mean, I remember paying it off in one go. And I was like, this is amazing. I was literally smiling, paying my tax bill, whereas here, I’m dreading it. Although, you may sometimes think, ‘oh, the Sing dollar is weaker than the pound.’ But you have to also factor in massively the tax advantage. So is very low in tax. So the range you gave there of six to 20k. I completely agree with that. And if you’re someone who’s doing lots of implants, which are partially, you know, the surgery aspect of the implants, you do have some insurance in Singapore, you know, forget what it was called, what’s it called? [Surinder]So with DPL you basically upgrade your insurance to it. [Jaz]With the DPL, which is, by the way, the indemnity as much as well, I meant a patient’s when they have a surgical procedure, ie wisdom tooth removal, or medicine, everyone has like a bank of money that they’ve been saving up towards which they can then offset against the cost of surgery. So it’s as if they’re not paying. [Surinder]They are paying, but it doesn’t feel like it’s hot, you know, [Jaz]they don’t feel like they want to use their medicine. [Surinder]So it’s basically permanent residents, or people that are citizens of Singapore, they’re paying to a part every month that comes out their salary, where they make a payment, and they say this up over time. And that can be used towards housing, it can be used on care, on health care, and they can use that for surgical procedures, as we said, just need and also implant surgery and various other things. [Jaz]So there’s that aspect. And the funny thing was in Singapore, is that wisdom teeth removal is so routine, right? In primary care. And I think one of the reasons is, every country, every system, even here pre and post 2006 of the contract, is that the way you get remunerated does impact the way you do dentistry. I mean, I think we just have to accept that firstly, right? [Surinder]I think we do have to accept that to a degree. And I think that, you know, every dentist has their own clinical judgment. So when you come here, as a dentist from the UK, your mindset is very different. It’s very, very different. But you can you can maintain that. I mean, a very early on, I think was Raj Ratan said to us on our kind of Dental foundation year, your standards will drop without you even realizing and this is something that we go through going from a young dentist, you go out in the world and you kind of realize, oh my gosh, like things are a little bit different, however, can maintain our standards as we go along, you know, even though the system dictates one thing or the other. But what I have seen here in comparison to the UK is that wisdom tooth removal is a lot more common, a lot. [Jaz]Well, there we are, we’ve got the nice guidelines here whereas the guidelines that they seem to follow in Singapore is that the only time they don’t remove wisdom teeth in Singapore is that if they’re congenitally absent is the feeling that I got really, is that you literally have to be born without any wisdom teeth for them not to remove it that’s how I felt, you know, with all the dentists around me, but you know, with people were coming in pericoronitis and they want their wisdom teeth out, it was a real opportunity for me and I took it, I bought a surgical NSK 45 degree contra angle handpiece and I did it I went for it and I was I really gained a lot more confidence out there in surgery, in wisdom tooth removal and I think sometimes you just have to put yourself outside your comfort zone a little bit. I mean, I did have some DCT, two, so Oral Surgery experience, but she use it out there. So if you’re good at surgery, if you can do implants, if you can do orthodontics, these are all, obviously quite lucrative areas, I suppose. And that’s what would push you up higher. But all of that depends on getting a good patient flow. My wife was working in quite a quiet area of Singapore, and that her income was more in the lower end, I was in a busier clinic. But the type of dentistry I found that I was doing was pretty much I think, if I was to describe it to be like, fee per item NHS, what do you think about that? [Surinder]Yeah, absolutely. I mean, there’s a massive range. I’ve worked, I think, for three different corporate companies here, and around 15 different clinics, and they’ve been in all sorts of different areas. So in the centre of Singapore, you’ve got the central business district, the CBD, and then towards the outer areas, you’ve got the heartlands. Now, heartland dentistry, you have a lot more local people. And in the center, you have people working in the banks and in the city, the demographics are completely different. And it’s a fee per item system. So if you’re working in private practice, you will have be faced with that, which is again, different to the NHS. The other thing is there a kind of government subsidies called CHASS, the community health assistance scene scheme. People can be subsidized with that if their household earnings are under a certain range. But yeah, it’s interesting. Some patients I mean, particularly in the heartland, they’re in pain, they were not sorted, you’ll go in there and you’ll be like, “Oh, my goodness, when was last time you see over dentist many years ago”, and there’s caries everywhere. They don’t want to touch it. Other areas and it’s more prevention. And you kind of doing the scaling and polishing other areas, people have lost teeth, they want to do treatment, other areas, they want a static treatment. It really there’s a big variation. [Jaz]This is Singapore’s, I think, the second most densely populated country in the world in terms of population density. And working in two or three different clinics out there. And just like you said, I think the demographics really, really can massively influence the type of work you’re doing. I mean, I was doing loads of dentures and looking but talking that in the heartlands where I was working, and I was doing lots of extraction. So it felt to me like fee per item NHS, that’s why I was saying, it didn’t feel like it, you know, I was in private practice, but it wasn’t fancy. Whereas when I was working in a few other areas, there that sort of dry for aesthetic, you know, people would clean them out. And active work was more, but I think if you’re going to be going in thinking, Okay, so your private practice can be really fancy. There’s no disease out there, then you’re definitely wrong. There’s a plenty of disease out there. [Surinder]There’s a lot. It’s just what the system is here. So you do have hospitals here as well. So you have hospital dentistry, you also have polyclinics. So there’s smaller clinics that patients can go for treatment, and you have the Health Promotion Board. So there are other salaried kind of areas that you can work in. But it’s not like what you would think in your head as a UK dentist, private dentistry is not that kind of mindset. It’s very different. The reality is very different to that. And I mean, like the population is like 5.6 million, I believe. And, you know, we’ve got about 2000 and two thousand and a half dentists, where and there’s a demand, there’s a need for dentists here, there is actually a demand at the moment. So that’s something that the government are working on. And I think the intake at the university here has increased to try and meet that demand. [Jaz]Brilliant. Well, that’s one of the things that I read about before moving to Singapore. But let’s talk about the current realities, as I understand them. So if you’re someone now looking to find a job, okay, am I right in saying that it’s much more difficult to when you or I were applying for a job? As a foreign grad, be in whether you’re from the USA, UK, wherever. [Surinder]So as a foreign graduate, so you can be from Australia, New Zealand, Hong Kong, USA, Canada and UK. If you’re not from those countries, you probably need to sit in examination to get in and practice here. But it’s changed a lot. Some of the main issues are the conditional registration. So when you come here, as a dentist from overseas, you need to be kind of supervised. So you have a supervisor in practice. Now previously, the supervisor only had to be the number what so one supervisor later on, they’ve changed it to two and I think this was since when you were here, Jaz, actually 2017. [Jaz]I have a last few intakes or the last intake whereby, the culprits were like, Okay, come on over. I mean, I found a dead easy shot. But after that, I’ve seen a big change and people were jobless for quite a few months, and I think I really want to send that message to the listeners. Because if you just think is going to be really easy getting the job. There are lots of barriers. And the main barrier is your unconditional registration. So there are limits to you being able to practice alone and whatnot, and therefore you need a supervisor. And a supervisor, I suppose, is like having a df one trainer in the sense that your DF one or VT trainer has to always be there technically, whether or not they’re actually mentoring you or not is a complete different story. I mean, that’s not exactly what it’s designed for, is someone just to tell the Singapore dental council that you’re safe, and that you are able to practice safely. But this is the issue because a lot of the surgeries in Singapore are single handed? [Surinder]Yeah, for sure. So I think this is one of the problems is that a lot of the companies here are a little bit more reluctant to take on conditional registrants because they don’t have the capacity to provide supervisors. And the Singapore Dental Council has actually said we need it. We’re going to be inspecting, we’re going around, and we’re monitoring this. So when you and I applied Jaz, it’s a completely different story. Now, I’ve spoken to a lot of people that have come over here, similar conversations like this, and they’ve struggled to find work, whereas for me, it was Google. For you, it was yet applied to this company. And it’s not quite like that anymore. [Jaz]Yeah. And are you fully registered there? [Surinder]I’m fully registered. So it takes two years. [Jaz]It supposed to take two years, but I’ve heard from some colleagues, we get some rejections. It can take up to three years, maybe more, and you get some rejection and whatever reason, so be prepared. [Surinder]You need to be working more than 30 hours a week and your supervisors need to submit the relevant documentation to the SDC. They’re kind of check everything. I was really lucky. And I got it first time. So I literally sent in my application, they okayed it straight away. I know people that have had to redo six months, 12 months, even longer to get their fully full registration with the SDC. So it does vary. [Jaz]Brilliant. Thanks so much for clarifying that. Okay, the next thing I want to ask you about is another question I get is GDC registered dentist. When they come to Singapore, and let’s say to start working there, should they continue to pay their GDC subscription? [Surinder]That’s a great question. So I’ve paid 890 pounds for the last four years. And I kind of feel that it’s a little bit like dead money, like it’s not really going anywhere. I would say that if it’s a short term move, absolutely, just pay it like what I’ve heard, and this is completely hearsay, that it’s quite tricky to get back on the registry, it can be difficult, whatever. I don’t know if there’s any truth in this. I know people that have come from Singapore have come off the register, have kind of got all their CPD together, submitted it, and they’ve got back on. It’s been a laborious process. But they’ve managed to do it. So if you’re okay with waiting, and you’ve got all your documentation, particularly with that enhanced, then maybe come off it. For me, I’ve got one day left to pay it and I’m seriously debating “Am I coming back?” [Jaz]You haven’t pay it yet? [Surinder]I haven’t. I’ve got one more day, I’m going to call them tomorrow to see like, you know, I’ve emailed them, they haven’t got back to me. So, but it sends off many jars. [Jaz]It’s a big talking point. And me and my wife, we paid it because we came to Singapore. I think my wife came with a short term outlook. I came with a long term outlook. I think it depends on your personality type. Are you a risk taker or not? [Surinder]I mean, I don’t think it’s going to be too difficult to get back on. As long as you’ve documented all of your CPD, you’ve done it. You’ve got it all kind of together. But yeah, I’m hanging on there. But I’m still not paying for this year. I don’t see myself coming back to the UK anytime soon. And that’s probably the reason, it adds up, it just add up. [Jaz]Yeah, and my personal recommendation would be that in your first year, just pay it. You never know. Or you might move back and you don’t want the hassle. But if you’re there, and then you are in a situation whereby you’re working for a few years, you then get the full registration from the condition and really don’t think you’re going back then maybe that’s a point whereby you can consider not paying your GDC subscription anymore because you’re pretty much in a flow, you’re settling in that way, is that fair advice? You think? [Surinder]I think it’s fair, but I know plenty of dentists from the UK here that still pay it and they’ve been here for years and years. So yeah. If I get any more information on this, I’ll send it your way. [Jaz]Sure. Thank you so much. So what was it like to live in Singapore? Can you give us a flavor of the living cost? So how much you know what’s the housing situation like? schools for kids? If you know that I’m not really sure myself to be honest. What can people who are looking to move to Singapore budget in terms of is it expensive country? Is it quite easy to get by? Any sort of light you can shed on that? [Surinder]Absolutely. So I’ve been here for four years now and I’ve lived in three or four different areas in different places. The rentals in the city centre obviously more expensive, you’re looking at London prices. So Sing dollars, 3.5k you can go up to ridiculous numbers like 10k. The living situation here is you have condominium, so they’re like flats. So a lot of people live in flats. Then there are these other things called landed properties, which are also known as houses, normal houses that people don’t tend to live in so much here. And you also have walkups. So walk ups are basically walking upstairs into your flats. Benefit of condominium is you’ve got a pool there, you’ve got a gym that is pretty standard. And you can see a two bedder in one of these may be between 3.5k to 5k per month. That’s kind of what you’re looking at. You have three bedders, they can go basically they’re kind of in ranges going up and up. And it depends on what area and city center is cheaper. Go and you go out you get more for your money. So but then you’ll be traveling in. I say traveling in but the kind of longest you go into communities probably about 14 minutes on public transport, most probably, depending on where you’re working. [Jaz]Sure. And the public transport is amazing in Singapore that MRT, the tube if you like is so clean and efficient. Ubers are cheap. Still. Is that still the case? [Surinder]No. It was out. It was gone. All this county company policies, but they’re out now. And we’ve got grab, so it’s mainly grab taxi. So it’s cheap, definitely cheaper than the UK but the prices are kind of going higher and higher and higher. That is that kind of vibe at the moment. So yeah, no Uber anymore, Jaz. [Jaz]Those who are listening, it’s a real shame but those who are listening, and they have no idea about Singapore and they think they’re just gonna rock in, buy a car, you know, just explain. I see probably don’t need a car unless you’ve got a massive family or something. And to buy a car is maybe six to seven times more expensive, let’s say to here. [Surinder]It’s very expensive to buy a car. And then even when you buy after 10 years, it’s meant to be sent scrap, like the kind of thinking behind it is to try and control the traffic on the road. It’s a very, very small island. But it’s very, very expensive. Some people have cars, I know people here that have cars, they have kids as well. But like you said, Jaz, the public transport needs to really go, the buses and the MRT, the mass rapid transit, really convenient and really easy and they’re basically everywhere. So it’s really easy to get around. And it’s a small island, you’re not really traveling long distances a lot of the time. [Jaz]Yeah, you can literally do the whole thing. If you go on holiday to Singapore, three days, you’ve done the whole of Singapore. [Surinder]You can really get around. [Jaz]Exactly. Which we’ll talk a little bit about how we can make the most of your time in Asia. I mean, you’re wonderful at doing it. It’s traveling the rest of Asia because otherwise if you just stay in Singapore, it can get a little bit boring I suppose, this is tiny island, get Island fever. So, you know, tell us about the traveling adventures that you can have when you’re in the heart of Asia. [Surinder]Yeah, there are so many I think the first year I came here, this is quite ridiculous. We went overseas about 12 times like it’s absolutely ludicrous. So Changi Airport is really efficient. [Jaz]My favorite airport in the world. [Surinder]So efficient. I think I got back. I landed this morning, I got into my bed in an hour. So I did take a grab. But I was straight back in bed. It was awesome. There are loads of places you can travel. Malaysia is literally just up the road. Thailand is an hour and a half away. Philippines, Bali, Hong Kong, Taiwan. Perth is like maybe four hours away. So it’s a really great hub. I would say that if you really want to travel and see Asia, it’s a great place to be situated in, you can make sure you go away for a weekend. So we often go to Phuket for kind of a weekend. There are some places that you can train that. If anybody does CrossFit or is into yoga or exercise or some really lovely beaches in Thailand as well. Malaysia, you can actually drive over that’s an option or get a bus service in Malaysia. [Jaz]It really is so close to Malaysia, I had nurses who commuted from Malaysia to work every day. [Surinder]Absolutely. I have that as well. And then literally, I think it’s like one to two hours to get in Singapore, depending on traffic, but they do they commute from there, because it’s cheaper to live there than it is in Singapore. [Jaz]So it’s really a great travel hub to explore the rest of Asia. So that is brilliant. What else can we talk about to give the listeners a real good insight into moving to Singapore what they need to know. [Surinder]And so I think that the culture is actually very different when I came here, I’ve never been to Asia, I’d never been to Singapore. I kind of really underestimated the move. I just kind of like yeah, I want to do it. I’m gonna do it and I did it. And it took me a while to settle in, but you kind of have two things. The first thing is that you take all your stuff, your personal issues and everything you take them with you wherever you go. There’s no running away from your own stuff if you’re looking for a better life, you’re still going to have to do the self work wherever you go in the world. The second thing is you will create whatever it is you want to create. So for me when I came here, it was really important for me to plug into communities. So I’ve got involved with the Singapore Dental Association and I got involved with like various other things and activities that I was doing in the UK there’s a really big expatriate community here as well so you will make friends and local community as well really, really awesome it’s a different mentality. British banter wise it’s very different so you need to be prepared that you’re moving to a different country and to really immerse yourself in the culture, different food, different people, different climate. It is very humid here. You will be sweating profusely pretty much all the time unless you’re indoors, it’s like the opposite of the UK, indoors here you’ve got your coat on because of the aircon, outdoors you go out to warm up that’s that’s certainly the case for me and my clinic weather. Fronts at the aircon in the shopping mall like super high. So it’s really interesting. There can be language barriers so if you’re working in the heartland be prepared for that, your nurse will also be able to translate but I do think there’s something to be said to be able to communicate well with your patients from a working perspective [Jaz]You know when I was there I learned how to say some, i’m sure you do as well, some things in dental related things. So I’m going to test you, Surinder, I’m going to say something Mandarin and let’s see if you sussed out what I’m trying to say. Okay? And for those of you who can understand Mandarin I do apologize for perverting your language. And what I’m going to say is ——- [Jaz]It’s a root canal treatment in the Mandarin. [Surinder]Oh wow. So —– have a rinse, Ni hao ma – how are you? [Jaz]If you say in Bahasa it’s —- That is what it’s all about. So when I was working in the heartlands, my nurses were fluent in Mandarin and Bahasa, which is you know, what they speak in Indonesia and Malaysia. So when you have those generation of patients, which is generally the elderly patients and the other hot tip, Hot Tip we have for those who are thinking of going to Singapore and working there is that the elderly men are called uncles. I remember you taught me that. When I came there, there wasn’t like lesson, Mandarin 101 Uncle and Auntie there’s no need to be apprehensive because this is something that you just pick up when you’re there. [Jaz]I’ll send you the audio bite for that later. Every time you get every time you get a message, you can make that your message tone as well. So, let’s, let’s talk about the expat community. Because, you know, I think 20% of Singapore’s expats? [Surinder]Yeah, I believe so. I don’t quote me on that. But yeah. [Jaz]That’s what I had at the time. And it was really amazing. You know, you can go to some areas, and it just feels like you’re in the UK sometimes. [Surinder]It really does. But it’s warm. [Jaz]It’s much much, much nicer and warmer and sweaty. [Surinder]Yeah, there’s a great community here. I mean, as certain areas are kind of more expat hubs or Holland Village, Tian baru, you’ve got the blend of expats, and you’ve got kind of an elderly population of Singaporeans. But yeah, it’s a really great community, you just need to plug into it. And there are loads of things on social media, loads of groups, expat gatherings, events, there are loads of things you can plug into. [Jaz]Lots of Americans being present, but also there was loads of American dentist working within our corporate. [Surinder]I didn’t I didn’t realize that. I knew there were a few but I didn’t know how many but I think actually a quarter of the corporate that you’ve worked for, Jaz, are from overseas. Foreign trained dentist. [Jaz]That’s right. And loads of them were American which really took me by surprise. So in my cowork about join, you know, those lectures that we’d have as part of it, induction, there was so many American dentists and in here I was thinking you know, and if you’re a American qualified dentist, you’re in such a great place, you’re going to be in the USA, which is the best place well to be a dentist, but here they are, they moved to Singapore. So that was a really interesting to see that. And when you speak to these guys, you actually realize that it’s not as amazing as it might, we might think it is. It’s really is the perception. [Surinder]Yeah, the grass is greener, it’s perceptions. And everybody also has their own experience of a place like somebody might come here, they’ll be working in the heartlands. They might not like it, like poor patient flow, difficulty with language barriers. But somebody else might be placed somewhere completely different, different social circle and have an amazing time. So there’s that aspect of it as well. [Jaz]Brilliant, that’s amazing. I think we’ve got lots of good information to help everyone, get gain an insight into what it’s like working in Singapore. What are the next steps for you? I mean, you know, I think our listeners saw how passionate you are, what a good speaker you are. And you know, that’s your certified health coach, sort of hands on, in Singapore, with the SDA magazines, you’re always writing articles, you’re teacher of yoga? [Surinder]Yeah, I teach Kundalini Yoga, which is pretty awesome. So I’m doing classes at the moment in Singapore, we’re running workshops, and mindfulness and meditation. So that’s pretty cool. It’s kind of like a bit of a side project that’s going on. [Jaz]That’s really cool. And what are the next steps for you? I mean, do you think you’ll be in Singapore for next year? Or roughly, what do you think? How is your career gonna, and life gonna gonna fare in Asia in terms of what your plans are? [Surinder]I have got no idea. Something that I’ve really learned from moving is to be open and flexible, I think it’s good to have a rough plan of what’s going on. So I think we may stay here for the next one to two years, and maybe consider another country, we may end up staying longer. It’s a little bit open at the moment. But I have to say, after four years, I’m pretty settled here. And I’m really enjoying it. It’s taken a little bit of time, but it’s a really great place to live. [Jaz]It really was. It’s Asia light, as they say, it really is very liberal. It’s such a livable country. And I miss it dearly every day. And me and Sam are always sort of recalling experiences from from Singapore. And I know you’re super healthy, super vegan, that sort of stuff. But I really miss chicken rice and the local delight are fantastic, the Hawker centers. And if you don’t know what a Hawker center is, a communal eating areas, it’s that make it sound really bad. But it’s like this, you street food, but it’s dirt cheap. It’s really good. And it got high turnover. So you know that the food is fresh, and they cook it right in front of you. So I really miss having that community feel about Hawker centers? [Surinder]Yeah, sure. Like, I think in the 1960s, the guys used to carry around the carts and sell them on the streets. And then the government were like, right, we’re stopping there. We’re having you in a place. So you could get Indian food, you could get Chinese food all in the same place, and then just kind of eat together, which is awesome. Because you can get what you want and then eat together in that same area. So yeah, I know there are there are things in Singapore that when I come back to the UK, I’m like, Oh, yeah, this is like, and I realized that become very Asian as well. Like, around the world. I was in Australia recently. I was like, wow, like some of the things that I’m saying like can [Jaz]It’s singlish. [Surinder]English language like, so? Can you do this for me? Can. Instead of yes or no. And at first you’re thinking, what does that even mean? This is this stop thinking like that. Great is a brilliant. [Jaz]Brilliant. That’s one of the things I really miss about is brought back lots of lovely memories speaking to you today. So thank you so much for coming on the show. And I wish you all the best with your amazing ventures in Singapore. And thank you for giving us an insight into what’s like and what the requirements are to work in Singapore. [Surinder]Absolutely. If anybody has any questions, feel free to email me. I have loads of tips, loads of other information. [Jaz]What are your I think you’re @dr.surinderaurora on Instagram is that right? [Surinder]Yep. @dr.surinderaurora on Instagram. You can email me team@soulsmile.org, just drop me an email. I’ll get right back to you. [Jaz]Brilliant. All right. Thank you so much, Surinder, really appreciate it all the best, Surinder and I’m trying to think of —- [Surinder]It’s telling you you’re coming back. [Jaz]Hello, hello Chinese. I tell you about the app. Hello Chinese is a great way to learn Mandarin. [Surinder]I’m going to download that right now.Thank you so much for having me. Thank you. Jaz’s Outro: So there we have it everyone. Thank you so much to Surimder Auora for giving up her time to record this podcast with me. She was such a great interview guest and she really you know is a great speaker and I think anyone out there who’s into to yoga, into self development, into healthy eating, get in touch with her Instagram is @dr.surinderaurora and she is such a great and lovely person to connect with. As promised, I’m going to be attaching some notes to this podcast which we be able to be found on the blog jaz.dental. I’ll put it under an episode and then you can download the PDF version also see the written version as a reference. So you can have the link to the Singapore Dental Association jobs this that come comes out as well. And for the next episode we’re going to be having speaking with my colleague, Rob, who’s going to be telling us about Australia what’s involved in actually working in Australia. I’ve got Christina who will be helping with me helping us with USA which is something that’s I think everyone has considered but as soon as you find out that there are so many barriers to working in the USA, people kind of switch off so be really interesting having someone who on the show who’s a UK graduate who’s in the transition to perhaps working in the USA, so that’s really awesome as well. Listen, if you’ve enjoyed today’s podcast show or if you’ve gained anything from it, if you found it valuable anyway, please share with your friends, share it on Facebook, subscribe on iTunes, on Spotify, on Google podcasts, and I really look forward to connecting with you again for future episodes. Thanks so much for listening. Have a lovely 2019. Happy New Year.