Protrusive Dental Podcast

Jaz Gulati

The Forward Thinking Dental Podcast

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Apr 12, 2025 • 44min

Medication Related Osteonecrosis for GDPs – What You Need to Know (MRONJ) – PDP215

Are you confident in managing patients on bisphosphonates or biologics? Which medications increase the risk of medication-related osteonecrosis of the jaw (MRONJ)? How do you decide when to extract a tooth and when to refer to a specialist? In this episode, Jaz is joined by oral surgery consultant Dr. Pippa Cullingham to explore the complexities of MRONJ. They break down the key risk factors, share expert advice on when to proceed with extractions, and discuss the latest guidelines for managing patients at risk. They also discuss the importance of early assessment – by identifying at-risk teeth early, you can help prevent serious complications and ensure the best outcome for your patients. https://youtu.be/KnQoI8Z-FhM Watch PDP215 on Youtube Protrusive Dental Pearl: it is so important to assess patients before they start taking high-risk medications like bisphosphonates or biologics, using radiographs to identify potential issues. Extractions should ideally be done before medication starts to avoid complications, as MRONJ risk increases once treatment begins. Key Takeaways: Medication-related osteonecrosis of the jaw concerns medications other than bisphosphonates. Risk assessment is crucial when considering dental extractions for patients on certain medications. Guidelines from the Scottish Dental Clinical Effectiveness Partnership are valuable resources for dentists. Higher-risk patients require careful management and communication with their medical teams. Denosumab has a different risk profile compared to bisphosphonates. Patients on long-term bisphosphonates may still have risks even after stopping the medication. Dentists should feel empowered to manage certain extractions in primary care with proper guidance. The decision to extract a tooth should weigh the risks and benefits for the patient. Always assess the patient’s risk before extraction. Eight weeks is a critical time for assessing healing. Antibiotics are not recommended for preventing MRONJ in the UK. Radiotherapy history significantly impacts extraction risk. Referral to specialists may be necessary for high-risk patients. Need to Read it? Check out the Full Episode Transcript below! Highlights of this episode: 02:15 Protrusive Dental Pearl 03:52 Interview with Dr. Pippa Cullingham: Insights and Experiences 06:40 Medications and Their Risks 10:02 MRONJ: Incidence and Prevalence 13:13 Biologics and other medications 14:19 Guidelines and Best Practices 17:22 Managing High-Risk Patients 25:03 Prophylactic Antibiotics 26:55 Risk Assessment 28:47 Radiotherapy & ORN Risk 31:49 Tips and Key Takeaways 33:32 New Medications & Prevention Strategies For the best approach to managing MRONJ, check the SDCEP Guidelines and the American White Paper. This episode is eligible for 0.5 CE credits via the quiz on Protrusive Guidance. This episode meets GDC Outcomes B and C. AGD Subject Code: 730 ORAL MEDICINE, ORAL DIAGNOSIS, ORAL PATHOLOGY (Diagnosis, management and treatment of oral pathologies) Dentists will be able to – 1. Be aware of the medications that increase the risk of MRONJ. 2. Learn how to assess the risk of MRONJ in patients, particularly before starting high-risk medications. 3. Understand when to proceed with extractions and when to refer patients to specialists for management. If you liked this episode, check out PDP206 – White Patches Click below for full episode transcript: Teaser: Patients prescribed a bisphosphonate for cancer were at about a 1% risk of developing an MRONJ following a dental extraction. There's been an update. So it's closer to 5%, we think, but we're not sure if that's because there's increased follow up, increased awareness, more reporting of the condition. So closer to 5 percent on the cancer patients for an osteoporosis. It's bisphosphonate medication, it's around 0. 1, 0. 2, so it's a low risk. Teaser:A risk in itself is taking the tooth out, so we can’t forget that actually patients on these medications can just get spontaneous MRONJ, it could just happen without taking the tooth out. So the risk is the surgery itself. When you review at eight weeks, if you notice that there is non healing area, or you suspect it’s an MRONJ, you can yellow card it. So it’s like, you had the BNF and it used to have the actual yellow card in. Now online. So if you just Google yellow card and then you can report the adverse reaction to the medication. Jaz’s Introduction:If your patient is about to be prescribed something like a bisphosphonate or a biologic, it is so important that before they start these medicines, which puts them at risk of surgical complications, that you have an opportunity to do a complete assessment and decide, are there any teeth of dubious prognosis that need extracting? Because Protruserati, prevention is better than the cure. Because today’s conversation is all about MRONJ, which is medication related osteonecrosis of the jaw. It can be quite a nasty complication and something that we should be able to just consent our patients. Like the worst thing you could do is your patient is about to start this medicine or is already on this medicine and you didn’t warn them of this relatively low but serious risk. And we’ll go into all the incidences, prevalences, when you should extract in practice and when you should refer. That’s what this episode is about. I’m joined by an oral surgery consultant, Dr. Pippa Cullingham. And she does a wonderful job of summarizing this and a great guidance that I’m going to put in the links below is the STCEP guidance and also an American white paper for our colleagues in the U. S. Hello Protruserati, I’m Jas Gulati and welcome back to your favorite dental podcast. No, today is not occlusion. It’s not onlays and restorative and vertical preparations. It’s Oral Surgery, and it’s not even the sexy part of oral surgery, right? It’s not like how to do the sectioning, elevating. This is medicines and their complications, and all important daily decision making. I’ve got such an aging population that I treat, so this is very real and relatable to me. And all you general dentists around the world, you have patients who are on these medicines. And there’s always a risk calculation that we need to make. And I’m hoping this episode will give you the confidence to know when it’s safe to extract in practice. And the two main reasons that you should be referring to a specialist, perhaps in a hospital setting. Dental PearlThe Protrusive Dental Pearl, which is like this advice, this tip we give every PDP episode. It’s very relevant to the topic of MRONJ and BRONJ, which is bisphosphonate related osteonecrosis of the jaw. That’s the one that I was taught at dental school. But then of course, we realized that it’s not just bisphosphonates. There’s so many medicines that contribute towards this poor wound healing after extraction due to the alterational bony turnover. And we should be paying attention to this. And the pearl is that when you have that opportunity to intercept. Like for example, they’ve just been diagnosed with a cancer, unfortunately, or they have osteoporosis and they’re about to start a bisphosphonate or another condition for which they need a biologic, which increases their risk. It is so important to do a very comprehensive assessment, which should include multiple periapicals or an OPG radiograph. So you can see all the roots, like imagine seeing a crown, which has looked a little bit dubious and you’ve been watching it all these years has never really been symptomatic. But if a patient is about to start one of these high risk medications, it’s so important that you take a periapical radiograph or an OPG. You need to see if it’s in the patient’s best interest to have this tooth extracted before starting this medication. So you kind of need to change your mindset a bit to let’s see how it goes versus are there any dubious teeth that we should extract before a patient starts any medication. If you can identify any silent infections or dubious prognosis teeth, think of obviously leaking crown margins, which are subgingival caries, but no signs of infection, but really those teeth ought to come out. And that conversation at least needs to be had with the patient before they start such medication. The best time to extract is before they start the medication because there is zero risk. As soon as they start any of these medications, there will be a risk of MRONJ. And we’ll discuss in today’s episode about what increases your risk and whether there’s anything special we should be doing with our extractions. Hope you enjoy and stick around to the end. There are some CPD questions below if you’re watching this on the Protrusive Guidance app. And I’ll catch you in the outro. Main Episode:Dr. Pippa Cullingham, welcome to the Protrusive Dental Podcast. It’s so, so good to have you. You messaged me some months ago regarding a post that we did just about common medications. That was actually a credit to Emma, the Protrusive Student. She’s so good at sharing her notes and whatnot. And then you said you liked it, but there was a really lovely point you made. It was actually there was missing biologics and you really inspired me to connect with you and to bring you on today to talk about a really important matter that affects so many of our patients. It’s to do with BRONJ and MRONJ and all those things. And so it’s great to have you. Pippa, just tell us about yourself as a clinician, as a human, all those things as we’d like to know from our guests. [Pippa]So I am a consultant oral surgeon and I work at Liverpool Dental Hospital and have been a consultant here since 2016. Up to that point I was in Manchester at the dental hospital there doing my specialist training and I was an SHO all over the country. So I worked in the South West, in Birmingham, I trained in Sheffield. So professionally I’ve been all over the place but we’re fairly settled in Liverpool professionally and I live in Manchester still. As part of my consultant role. I do a few other bits and pieces. So I’m the department lead in the hospital for oral surgery. I’m also the quality improvement lead for the hospital, for the dental hospital within our larger trust that we sit within. And so I find there’s a lot of crossover between my roles. I’ll see an individual patient and think, hang on, maybe we can improve on that. And that links in with my specialist role, which links to my quality improvement role. So it, it all links in together. And it means that I do a bit of nonclinical and a bit of clinical alongside a small family, young family. So it’s busy, but it’s good. [Jaz]Amazing. And for those of you who are listening on Spotify or Apple, Pippa’s in surgery. Is this your hospital surgery? [Pippa]Yeah, this is in Liverpool Dental Hospital. [Jaz]Amazing. And so thanks so much for making time for this, actually. Interesting observation, actually. Oral surgery, like when I used to be a DCT in oral surgery at Guy’s Hospital, I noticed that a lot of the registrars were women. And every time I see someone now getting a new post, because I know it’s very competitive, there’s only a few posts, I see a lot of women in oral surgery. And I think when you look at medicine, how surgery is often dominated by men, do you think that oral surgery is the exception? It’s quite different. I see lots of women in oral surgery. Do you observe that as well? [Pippa]Yeah, I had a similar observation. We have registrars training with us. We’ve got two at the moment and they sent me a photo of their recent study day. And I think probably about 80%, 90% were women of the photo of them all sitting, listening. So I do think it’s a really attractive career. I think dentistry is an attractive career, particularly for a woman. And I think if you think about oral surgery specifically, a lot of us start as Maxfax SHOs and maybe Maxfax isn’t as attractive to women, certainly my personal opinion. So I think as an undergrad, I think it’s about 55% women to male. I think there’s a male. [Jaz]Yeah, I thought 60% actually, so you’re right. So there’s more women, but yeah, it’s an interesting observation, but we want to talk today about the different medications that I have aging population that I treat and on our community on the app, actually, a lot of the questions that we get are about, well, my patients on these medicines. And I’m a little bit nervous about doing an extraction, and I can only imagine the number of referrals you get. And then, for some of these, you may be like, actually, the GDP should be doing this extraction. And for some of those, it’s like, yeah, this is a good save. I’m glad we are doing it. And maybe you see the other side whereby you kind of wish the GDP had referred this. And so, I’d love to just go into those three types of scenarios. And before we delve into that, let’s just start with, like, definitions, right? I always heard of BRONJ, right? Bisphosphonate related, I used to, as a student, say osteoradionecrosis and they said, no, no, no, it’s radiotherapy, that’s different. So osteonecrosis of the jaw. And then MRONJ is just a wider term to encompass more medicines, right? [Pippa]Yeah, so increasingly there’s more medicines. So we have a new diagnosis that’s used for a group of conditions, quite wide conditions, that aren’t bisphosphonates, but they are having the same effect on the jaw or can have the same effect on the jaw. So rather than the BRONJ or BRONJ, so bisphosphonate related osteonecrosis of the jaw, it’s been reclassified for the last 10 years or so as medication related osteonecrosis of the jaw, because we know there’s more medications that aren’t bisphosphonates that can cause that reaction in the jaw, and also they’re still emerging. So the biologic immunological medications that are newer. Some of them, we don’t know which ones, not all of them, but some of them will cause a reaction as well sometimes. [Jaz]Someone literally like 20 minutes before we start recording on the community mentioned about their patient and posted a radiograph about Denosumab. Is that one in consideration? [Pippa]Yeah. So that’s one of the similar to bisphosphonates, but it’s not a bisphosphonate medication. And actually it’s given a slightly different way. So it’s not a tablet or an injection. Well, it’s an injection, but it’s subcutaneously. So into the fat rather than IV, and it’s got a shorter half life, but yeah, it works in a similar way to bisphosphonates, although it’s not bisphosphonate, it affects the osteoclast still, it binds to one of the enzymes and stops bone turnover. So the half life’s shorter, it’s not supposed to be as potent, and you can actually, we’ll talk about maybe timing extractions, but Denosumab is one that you can potentially, if a patient’s still on it, time your extraction so that the half life’s lower and it’s excreted from the body. So your risk is that a little bit lower if you’re able to if the patient can defer an extraction for a little bit longer. [Jaz]Well, it’s really important for us to know this because sometimes our patients are about to start these medicines and we have that little window to intervene before they were to start it. Obviously, prevention is the best way to go. So before they get on the medicines and I’m sure you have a strong opinion on how perhaps in the medicinal world they are probably not doing enough to point them to dentists or maybe that’s changed. How do you feel that’s going in terms of general dentists having the opportunity to get rid of or extract the more dubious teeth, which may be a problem in the future? Is that communication there yet? [Pippa]I think it’s probably hit and miss. We have some patients that are directed to, well, we don’t see them because we’re not the primary care dentist, but they’ve definitely been advised to see their dentist for the dental check before. That bisphosphonates start, I’d say particular cohorts are probably better. So the cancer patients tend to have a better workup, although the timeframes may be a bit more sort of urgent and compressed, but I would hope over the years it’s more reported, isn’t it? The MRONJ general’s a bit more aware of it. So I would hope that it’s improving that whoever’s prescribing that bisphosphonate medication will encourage the dentist to see the general dental practitioner. [Jaz]And in terms of how much of a problem this is, like for example, incidents and prevalence. These are two things that we’d like to know because it’s something that when we see a patient and I see a patient and it’s written on their medical history that they’ve been taking and running acid. And I think back to the guidelines and I’d like to know which are the best guidelines that you’d recommend because there are a few, I believe. And so we’re good at looking at that. And then we look at the other risk factors, how long they’ve been taking it. We’re trying to do a calculation. Is this safe? Is this not? But what I’d like to know from you is, okay, what is the general instance like? And then if you have the data available, are there some medicines or some routes that are worst offenders that we should be particularly waving a red flag when we see this medicine in a medical history? [Pippa]Yeah, so I’d say overall it tends to be the condition that affects the risk factor. So the patients taking a bisphosphonate or an anti-angiogenic, because that’s another group of drugs that can cause the MRONJ, tend to be slightly higher risk than maybe your osteoporosis patients that prescribed a bisphosphonate. So increasingly, it was thought that looking at larger studies that patients prescribed a bisphosphonate for cancer were at about a 1% risk of developing an MRONJ following a dental extraction. There’s been an update, so it’s closer to 5% we think, but we’re not sure if that’s because there’s increased follow up, increased awareness, more reporting of the condition. So closer to 5% on the cancer patients. For an osteoporosis, bisphosphonate medication. It’s around 0. 1, 0. 2, so it’s a low risk. [Jaz]So this is for the osteoporosis cohort, right? That’s lower risk. [Pippa]Osteoporosis is lower risk. Yeah. [Jaz]So it’s the number one question for a general dentist is basically for what reason did your doctor prescribe this? And then that will give you the big clue, I guess. [Pippa]Yeah. So probably the cancer patients are slightly higher risk. Well, they are slightly higher risk than the osteoporosis patients. And then there’s also the thinking with bisphosphonates because it can be given annually via an IV infusion or patients can be taking it weekly with their tablet, just an oral tablet. Previously, they’ve been thought that actually the IV route was high risk and more recently the thinking is actually for osteoporosis, oral, it’s the same as IV. [Jaz]Okay. That’s interesting. Yeah. I didn’t know that. And then also I’m just thinking back to my undergrad days and the stat I was quoting at that point, early in my career, and maybe it’s still stuck with me now and I’m not as up to date as I should be. And I’m being, to be very honest here is that there was oral, which was like 1 in 1, 000 to 1 in 10, 000 risk. Do you remember that being quoted? And then IV was like 100,000. But then what you’re suggesting is that actually, they are wildly higher than what I’ve just said there, what the previous guidelines believed. Is that right? [Pippa]So if you’re osteoporosis is 0.1 that would be at 1 in 1, 000, wouldn’t it? [Jaz]Yes. Yes. [Pippa]Yeah. So it’s about the same. And yeah, 1 in 500 is 5%. You’re testing my maths now. What was that? [Jaz]0.05? No, it would be 0.5%. Yeah, fine. 5%, one in 20, one in 20 is quite a fair bit there. So that’s definitely something that we should be at the forefront. So the first thing you’ve already taught us is, okay, ask why they’re taking those medications. So if it’s cancer that’s higher risk, if it’s for osteoporosis. Are there any other reasons that people beyond these biologics that we need to be aware of? [Pippa]So the biologics are another group of medications or an immunomodulator drugs where actually quite a lot of conditions are starting to use them. So it’s maybe long term chronic conditions where they might have been on long term steroids or azathioprine to reduce an immune response just generally in the body, which has unwanted side effects. So the cleverer drugs, the more recent drugs are just targeting specific parts of an immune system to dampen down inflammation or any negative effects of the condition. So dermatology use it quite a lot in psoriasis or eczema, severe eczema. Gastro use it for sort of the management of Crohn’s or ulcerative colitis. And then biologics are also used in cancer treatment as well. [Jaz]Is there a handy list of these medicines? Because quite often we see these newer ones and then we may not identify like alendronic acid has been ingrained into us. That’s an easy one to identify. Denosumab again, a lot of people talking about it, but there might be so many that we might see, which is, I mean, the main lesson there is if you see a medicine, you don’t know, Google it, like look it up. It’s just a BNF, whatever you can just first thing to do is look it up. But is there a handy resource, any guidelines that you can point us to that we should be sticking up on the inside cupboard of our surgeries? [Pippa]Yeah, absolutely. So the SDCEP guidance, Scottish Dental Clinical Effectiveness Partnership or Programme, they’re really robust, they’re really clear, they’re aimed at primary care, they’re evidence based as best as they can be, but also quite pragmatic in how you risk assess patients. They’re also really supportive of that dentist being, that patient being managed in primary care, because actually, unless you’ve got a very medically complex patient that’s not okay to treat in primary care, what you do in primary care is not going to be any different to what someone does in a hospital for taking a tooth out. So it’s probably quicker, the patient’s getting the best treatment at the right time without a lengthy referral into hospital a lot of the time. So it’s only really medically complex patients that I would consider referring or complex surgical procedures which need a bit of support from a specialist or someone with additional skills. [Jaz]So that’s a really lovely summary. So medically compromised and also a tricky extraction, which we’re used to referring anyway. So what you’re saying perhaps is someone has had cancer and for that’s the reason that they were given, let’s say a medicine such as it could be a bisphosphonate or it could be, what are the other ones that you mentioned? Is it methotrexate? Does that count as well? [Pippa]So methotrexate counts as a biologic. It’s an anti resorptive medication or anti- Yeah, anti resoprtive, I think. So yeah, that will have a similar, it is linked to MRONJ. It can have a similar effect. Yeah. [Jaz]So we’re on that for a reason of cancer. So automatically we identify, okay, this is a potentially higher risk patient, but the extraction is not particularly difficult and they’re not medically compromised. Would you recommend general dentists to take out the tooth or, because often we’re scared and we refer. Do you think that’s an inappropriate referral? What guidance could you provide us? [Pippa]I wouldn’t class it as inappropriate. I think often it’s the sort of the unknown, the sort of uncertainty, not wanting to do the wrong thing, not wanting to have a complication that maybe you don’t want to deal with. So I absolutely understand the reason for referral. Maybe a methotrexate patient, maybe a rheumatoid arthritis patient. So long term, chronic, might have other comorbidities, so could be on long term steroids, which ups their risk a little bit. I would always encourage maybe a dentist to ask for advice or support. I don’t know in the local area if there’s someone that they can just email or phone or get a bit of advice because that’s far better for the patient than them ending up in this lengthy referral system. But yeah, if it’s a tooth they can take out. If it’s a patient that’s safe to be treated in primary care so there’s no, the cancer patients, if they’re undergoing chemotherapy, may have some blood issues with the bloods that you might want managed somewhere else or might want to investigate it before taking the tooth out. But for say a chronic rheumatoid arthritis patient on methotrexate, who maybe hasn’t had that much long term steroids or no other complicating factors. I’d take that out in primary care. [Jaz]Okay, great. And it’s nice to have that. But if in doubt, reach out to someone who can help you. The local area team, the local hospital. So for me, that’s like Royal Berkshire Hospital. They’ve got the OMFS department which can often give us advice and whatnot. So that’s a very sensible way to go. You mentioned already steroids increasing your risk. I remember smoking is linked to increasing your risk. Are there any other things that we should be looking out for that, okay, on balance, all the holes are lining up in terms of the Swiss cheese model and then medically compromised, trickier extraction on this bisphosphonate for cancer, but also has been smoking and steroids and it’s all like becoming a higher risk. Any other things that we’re missing out in terms of things that also increase your risk. [Pippa]So, I think a risk in itself is taking the tooth out. So we can’t forget that actually patients on these medications can just get spontaneous MRONJ. It could just happen without taking the tooth out. So the risk is the surgery itself. But it could also be things like poor fitting dentures, unmanaged perio, mucosal trauma. Just generally a mouth that could be improved is always going to lower a risk of a patient. Other things like the length of a bisphosphonate medication, so the risk seems to increase a little bit once a patient’s been on a bisphosphonate medication for over five years. And I think, again, it might be a bit patchy, but the risk assessment and the monitoring by GPs or whoever’s prescribing that bisphosphonate medication seems to be happening a little bit more. So what are the benefits of a patient staying on a bisphosphonate for over five years if, say, it’s for osteoporosis. Have they gained the benefit in five years and can they be removed from it? But then we have to consider that actually the half life of bisphosphonate, Alendronic acid, is about 10 years. It binds so well to hydroxyapatite that it stays in the bone. So even when they’ve been on it for five years, the effects are long lasting. So if you know a patient has taken it previously, but isn’t currently prescribed it, that you still have to factor it into your risk assessment as if they’re still taking it. [Jaz]And you mentioned earlier about denosumab being a bit different. So it’s well known that it’s got such a long half life, andronic acid, therefore if they stopped taking it two years ago, but they were IV, they were taken for cancer reasons that we still include them in the high risk category. But like you said, if the tooth is simple to extract and there’s no other additional factors, as long as we consent our patient, we tell them we can take it out in practice. That makes perfect sense to me. But in denosumab, it’s something different. You said that perhaps they can come off it. Tell us more about that. [Pippa]So I wouldn’t ever advise, without the guidance of whoever’s prescribing that drug, that a patient stops it. Because I think it’s really important if we think about why a patient’s taking it. It’s for really good reason. So for osteoporosis, they’re taking it to reduce their incidence or probability of having a fracture, which the comorbidity of a fracture in an osteoporotic patient is high. So the risks of fracture and the results of that is we just don’t want that to happen. So they’re taking it for really good reason. You want to keep them on it for their bones, but it can have a small risk of this medication related osteonecrosis of the jaw if we need to take a tooth out. So I think context and pragmatism is really important. They’re on it for a good reason, but yeah, some things can be mitigated. So if it’s a tooth that needs to be taken out and it’s a patient who’s on denosumab. And they have it every nine months. Say they’re at month seven, that’s probably a very good time to start thinking about taking the tooth out so that you can take the tooth out at month seven or eight. They’ve got two to four weeks to heal and then they have their next injection for the denosumab. But actually, even if they’re still on the denosumab, they had it recently. It’s a low risk. [Jaz]Okay. So denosumab is in the lower risk category. Like you said, I think you said it was subcutaneously given. It’s important to recognize it in medical history, but if it’s just denosumab and no other factors involved in terms of medically compromised, difficult extraction, steroids, et cetera, then that is something that, although ideally to time it, seven months after the first dose, that if they genuinely need the tooth out, it’s unrestorable that to do your usual local measures and not have to necessarily refer it unless there’s a good reason to. [Pippa]Yeah, absolutely. And we appreciate that sometimes patients are in pain. They just need that tooth out. It’s the definitive treatment. So it’s the advice that you give to patients that you recognize and consent that there’s a small risk that the area might not heal or might be slower to heal, but it’s the risks and the benefits, isn’t it? You’re in pain from that tooth and that tooth needs to be taken out and taking that tooth out is the best thing. Equally, you’re on a medication, which I don’t want you to stop. You need to keep taking it and even stopping it now for bisphosphonate won’t reduce your risk so keep taking it if that’s what your medical practitioner advises. [Jaz]For those higher risk patients that you get referred and you think yeah good thing the GDP referred here because they got all the risks there .There are 5% or even more basically and it’s a tricky extraction so more trauma and therefore more likely is there like, nothing that you, obviously you try and do it as atraumatically as possible. There’s no drugs or there’s no additional therapies that are used to decrease their risk, or is it managed in any special way in your hands? [Pippa]So before taking a tooth out, so you’ve just identified a slightly higher risk patient that needs a tooth taken out, I’d still say unless there’s a reason for them to be treated in the hospital, so complex procedure or very medically compromised, not necessarily the bisphosphonate drug or equivalent that they’ve been prescribed. There’s nothing I’m going to do that differently that a GDP can’t do unless it’s a difficult surgical procedure. So no, I think I’d always emphasize a pre op cortisol mouthwash and post op mouthwashes. I’d take it out as atraumatically as you can, which obviously you do for every patient anyway, but actually the SDCEP is encouraging dentists to take teeth out in primary care. It doesn’t mention any weird and wonderful techniques that we need to be using. It’s just a straightforward extraction as you normally would. If I was really worried about it, I might think about maybe using a periotome or maybe sectioning a multi rooted tooth just to make it as, sort of atraumatic as possible. But if a dentist doesn’t feel comfortable doing that in practice, then just a normal extraction technique is absolutely fine using luxators, elevators, forceps. And then you can hear different things. So if you’ve got a flap up, primary closure is great, but I wouldn’t raise a flap specifically to get primary closure. You can maybe suture across the socket just to approximate the gingiva a little bit more, just to encourage that mucosal coverage. But other than that, post op, mouthwashes, encouraging good oral hygiene, and a review appointment at eight weeks because the MRONJ’s diagnosis will only be made at eight weeks if you haven’t got full healing. [Jaz]Okay, that’s a good one. So there’s no necessary reason to review them earlier unless you think they just generally need it. But eight weeks is a good point to reassess and and what are you looking for? Usually we’re hoping that it’s healed by then, of course, but I remember Chris Sproat I used to be under him as a trainee in Guy’s and he described it as looking like porridge. Any comments in terms of what additional features we’re looking for that thing that, okay, this doesn’t quite look right. This needs a referral. [Pippa]So at eight weeks, I would want to see full mucosal coverage that if you have a good feel around the area, it’s not tender. You can’t feel any loose bits, any crunch, and you can’t probe down to bone at all. There’s no pain, swelling, pus coming out. The patient isn’t describing any sort of numbness or altered sensations. So that’s the kind of thing I’m looking for. But at eight weeks, if that is there, I would consider that a diagnosis of If the patient hasn’t had radiotherapy previously, that’s probably worth caveating as well. ‘Cause as you said earlier, it’s not in patients that have got radiotherapy. That sort of presentation in a patient that’s had radiotherapy is more likely to be an osteo radionecrosis. I would say at eight weeks. If you are seeing not full mucosal coverage, if you can probe down to bone, if it doesn’t feel quite right, if the patient doesn’t feel like the area’s healed. If you can feel a bit of tenderness, I’d refer for a second opinion, but up to that point. If you’d referred before the extraction, the hospital wouldn’t have done anything different anyway. So it’s just reassuring that you’ve done the right thing. If a tooth needed to come out, it needed to come out. No one would have done anything differently. But the best place for the MRONJ or potential MRONJ to be assessed is in the hospital. [Jaz]I imagine there are some GDPs and I think that logic. There’s a naughty thing that once a trainer taught me, okay? And I know it’s not true and I don’t practice this, but it was I remember listening at the time thinking, hmm, is that the right thing or not? Probably not. So basically, the naughty thing was, if ever you touch bone, i. e. you’re doing some form of surgical and you’ve drilled a bit of bone away, then maybe to prevent an infection, give antibiotics, like prophylactically, right? And so, am I right in saying that’s not a done thing, right? [Pippa]I wouldn’t recommend it for preventing MRONJ. There’s no definitive evidence that would support it. And I think we’re living in an era where we’ve got the answer. [Jaz]When I was taught this, Pippa, it was just generally any extraction, any patient, if you touch bone, give antibiotics, which I never employed, because it didn’t seem like following the guidelines. But yeah, a lot of people may think that, okay, if someone’s high risk of MRONJ, could there be a place for antibiotics, but you just covered it now, but actually we don’t need to do anything above and beyond the local measures. Of course, you mentioned the course of a mouthwash before and afterwards and good home care and good instructions from our patients, but we don’t need antibiotics. And this is a nice little message to reassure that we don’t need to be thinking about giving antibiotics. [Pippa]No, I’d really go anti antibiotics for the management of this. There’s no definitive evidence. And if you think about the antibicrobial resistance that we’re trying to fight at the moment, prescribing antibiotics for no given reason just increases problems down the line. And you’ve got the risk whenever you prescribe anything, that the patient might have an adverse reaction to it, and you don’t really want that on your- so no, no evidence to antibiotics. If you were to delve into, the evidence of MRONJ, so there’s an American white paper that gets reviewed every few years. It is mentioned that antibiotics can be used to prevent MRONJ, but the SDCEP guidance, based in the UK, aimed at primary care, really robust guidance, don’t suggest it at all, so I would err off antibiotics. Unless there’s another reason why you might want to give it but that patient is probably in the hospital. [Jaz]Very good to know and one thing that we haven’t covered yet was interesting is if the tooth is a dubious prognosis but if the patient’s other features like they look half themselves got good oral hygiene and the tooth is potentially restorable still although it might be tricky but still restorable yes, it might have really bulbous, curly roots, but that’s going to pose a difficult, difficult extraction. The endodontist might have a good crack at it and still try and keep that tooth. Is this a conversation that you’re having with patients to try and convince them that, okay, let’s go down the rehabilitative restorative route to prevent that trauma in the first place? [Pippa]I think it’s looking at that risk. So doing the risk assessment on the patient of risk of MRONJ versus risk of taking the tooth out. And actually, if you’ve got a patient who’s about to start bisphosphonates, so they’ve not got anything in their system now. So the risk of MRONJ is negligible, none. It might be worth having the conversation about actually is now the time that we take that poor prognosis tooth out because the risk is none. Whereas in six months, a year, five years. it’s going to be higher. So that’s the conversation before they start the bisphosphonate. If they’re currently on an anti resorptive, an anti angiogenic, or one of these biologic medications, it’s looking at that SDCEP risk assessment, which is really nicely done in a flow diagram. So I’d encourage dentists to have a little look at that. And actually, if they’re low risk, SDCEP don’t suggest discussing other options, like trying to maintain retained roots without infection or anything like that, low risk, they say, carry on with the extraction. If they’re higher risk, so it tends to be patients with existing MRONJ, or patients that have been on the bisphosphonates for a little bit longer, or the cancer patients prescribed some of the medications, slightly higher risk, then it’s worth considering whether teeth can be maintained, retained, endodoned, cut off and overdenture, or something like that. It’s only that higher risk really where I consider that conversation as long as the patient’s well informed of their risk, whether they’re low or higher. [Jaz]I have a patient who had radiotherapy in the angle of mandible, and there’s a lower right second molar, which had just the most bulbous curvaceous roots. And so although there’s not much structure to put crown on it, that was like as a root field by a specialist and just sealed over. It’s been going strong for many years now. But that’s a high risk of radionecrosis in that patient. I think that’s a good move in that kind of, if it was more simple atraumatic, then might be a different conversation. But you know, very nasty looking roots. So there is a place for that kind of conversation. Would you agree that perhaps radiotherapy in the jaw is a different conversation, higher risk, higher stakes? [Pippa]Incidence wise, the risk of ORN following a dental extraction is, is 5% to 6% off the top of my head. It’s not something I’ve looked up just to come to this conversation. But again, that has loads of factors as well. So it’s when was the radiotherapy? So the closer to the time of the procedure, the lower the risk, because the effects of radiotherapy happen over many years. So if you’ve got a patient that had- [Jaz]That’s interesting. You would think that actually is counterintuitive. Yeah. Okay. [Pippa]Yeah. So if the patient had radiotherapy last month, you’re probably going to get away with a lower risk extraction. If they had it 10 years ago, that effect of the radiotherapy, the reduced vascular structure in the jaw, the reduced healing capacity, everything’s fibrosed, they don’t heal well. So the length of time from radiotherapy to extraction is one thing to consider. Also things to consider, the dose of the radiotherapy, how many fractions, how long it was done over. So that has an impact, so different radiotherapy regimes and where that radiotherapy or where the primary cancer was targeted, so things like laryngeal, sort of ENT procedures, you’re probably going to be, if it’s anterior mandible, if it’s maxilla, not in the field of the radiotherapy, again it’s targeted now, they wear a mask, it’s all a bit more narrow, they try and limit the exposure of radiotherapy to other parts of the head and neck. If it was a base of term carcinoma, if they radiotherapy and the angle of the mandible is right in the beam, then yeah, you’re higher risk, aren’t you? So it’s just thinking about all of these things, but I would, any patient with radiotherapy, to be honest, I would probably err to refer. [Jaz]That’s a very sound advice, I think, because he’s got his own risks and there’s more data to be collected in terms of, okay, can I see the map of where the radiation was? And sometimes in hospital it is useful to have that. I’ve been seeing recently colleagues posting radiographs of roots being resorbed away. And then what they’re finding is that there are certain medicines implicated in that. Slightly different, obviously, I don’t think that comes anywhere near the diagnosis of MRONJ or maybe it does, I don’t know. But is this something that you’re seeing being referred in to you? [Pippa]Not that I can comment on. I can’t really think of any cases I’ve seen like that, to be honest. So I’d be interested to read a little bit more about that. Do you know, do they know what medication it’s linked to? [Jaz]Well, I felt as though they were saying denosumab. I felt as though I saw that come up, and then a few people have been saying that, oh, they’ve noticed a few of these, but I was wondering if you’d seen anything like this, because I haven’t seen it yet myself. So something that’s just creeping, some conversations happening basically, but of course that’s a bit different. In terms of just final tips for general dentists then, is a nice summary is don’t be so scared, because if you do a correct risk assessment, like you said, the fascinating thing is that the oral surgery department is not going to do anything different to what you could do. And as long as there’s no heart issues, severe asthmatic, medically compromised, then go ahead and local measures, perhaps a suture, like you said, a cross suture, no need for antibiotics, and have that just conversation. Anything that’s important to say in the realms of consenting a patient appropriately. [Pippa]I think it’s a conversation just to highlight that they’re on a medication that’s really good for their medical management, whether that’s the rest of their bones for osteoporosis, whether it’s for the management of their cancer or the management of their Crohn’s or any other sort of psoriasis condition, chronic condition. But we are seeing that sometimes patients don’t heal, you don’t heal particularly well having had a tooth out and there is a low risk that that area might be slow or not heal. That may not cause them any problems. So actually, MRONJ doesn’t have to be symptomatic. They may just have just an open area that they manage to maintain, manage to keep clean and that the hospital would probably keep under review just to check it doesn’t progress and hopefully it resolves with time. With time, what we hope is that the jaw starts sort of walling itself up off and that you get little loose bits of bone that work their way out, a little sequestry, and that allows the area to heal. So that’s the best case scenario if you do get an MRONJ. And I think that’s the discussion for the patient, that you need this tooth out, and that the risk is low. We’ll keep an eye on you, but we’ll get the tooth out and we’ll see how you go with it. And if they have questions or you don’t feel comfortable with their expectations in practice, then maybe think about referring to a specialist. [Jaz]Amazing. I think that’s a great conversation to have. And the worst thing we do is not have this conversation and miss the medicine. And medically, legally, that’s a minefield. So the top tip is if you haven’t seen a medication before, just check it out because it could be in these. And then there’s nuance coming all the time, basically. Any particular noteworthy things you want to mention regarding the newer medicines or things to watch out for, common mistakes a GDP might make when they’re referring, any concerns that they have? [Pippa]No, so I’d say things to look out for, they tend to, I mean, they’re so variable now and some of the biologics we know have caused MRONJ reactions but that sort of MRONJ, but that tends to be case reports. So they’re not, it’s not consistent necessarily. So if there’s a suspicion that a patient is on a biologic, look it up and just confirm what that is in the BNF. Again, probably not going to do anything differently. If you can comfortably treat the patient in practice. But when you review at eight weeks, if you notice that there is non healing area or you suspect it’s an MRONJ, you can yellow card it. So it’s like, you had the BNF and it used to have the actual yellow card in, now online. So just Google yellow card and then you can report the adverse reaction to the medication. So it just helps to add to that evidence of medications that might be causing these reactions. As you said, if you don’t don’t know what a medication is on the medical history, look it up in the BNF, just so you know. And then you can annotate it, can’t you on the records and just say what it is. But the groups of these medications, obviously the Alendronate. The Zoledronate, so eight at the end, some of the Angiogenics, a mab or nib. So Sunitinib or Ben. They’re long names, but they end with MAB or denosumab. So NIBS, MABS, and stronates. Yeah, I’d just be a little bit cautious of. Yeah, but anything else you don’t know, look up. The focus on prevention, so when they get the patient who’s about to start up bisphosphonate, the prevention and the fluoride oral hygiene diet advice, basically trying to maintain a dentition that you may want to take out a tooth that has a poor prognosis given their risk of MRONJ following dental extraction may increase. And also just thorough assessments, so taking radiographs to assess if you’ve got that sort of heavily restored crown tooth that you’ve just been looking at for 10 years. Maybe just take a PA of it and just make sure that it looks okay underneath before they start. [Jaz]Great. Nice summary. So Pippa, thank you so much for a lovely summary. I’m going to make the SDCEP guidelines available. Also the white paper because it’s difficult. It’s nice to see for our American colleagues how they are managing it as well. So I’ll put that all in the show notes. This episode is CPD and CE eligible. So thank you for your contribution to that. If anyone wants to reach out to Pippa, check her out on the Protrusive Guidance app, and it’d be nice to get real life, oral surgery, sort of experiences from you. And I think it’s great. Everything you’re doing in this really sweet of you to message and just raises very important topic that affects us in GDP land every single day and then help us to mitigate those risks. But the biggest takeaway for me was it was twofold. One was that you guys don’t do anything that much differently. And so there’s got to be a medically compromised reason to refer a tricky extractions that was encouraging as a GDP who quite likes doing extraction. So it’s good to keep it in house as long as you’ve had those conversations. And also the radiotherapy thing that actually the sooner you had the radiotherapy, the less risk you are. I didn’t actually know that. So that was a good takeaway from me. So, Pippa, thank you so much for that. [Pippa]Thank you very much for having me. Jaz’s Outro:There we have it guys. Thank you so much for listening all the way to the end. Thank you again to my guest, Dr. Pippa Cullingham for giving a very nice overview. And as promised, if you scroll below, whether it’s on Protrusive Guidance or YouTube, wherever, I’ll put the links to the two main guidelines. If you’re in the UK, SDCEP, US is the white paper it’s really important to look at what guidelines are in your country. Cause like you saw in our conversation with antibiotics, it can be a bit different. And those on Protrusive Guidance on a paid plan, you can answer the questions to get your CPD or CE credits. We are a PACE approved provider and excitingly later on in the year, we’re going to be having a core month. So we’re going to actually covering the core CE. So in the UK, for example, it is mandatory for us to do certain things like radiation or cancer diagnosis, medical emergencies. So we’re getting to a stage where we’re going to be providing core CPD, which is so important. We’re going to do it in a way to make it fun and engaging and an easy listen. And you get to just do a big fat tick on that mandatory CPD as well. The mission is to make it the best mandatory CE that you’ve ever done. So watch this space. And it’s a great time to join Protrusive Guidance on one of our paid memberships. If you haven’t already, cause there’s so much to come as well as the entire backlog of 300 plus hours of CPD available. Thank you so much for watching all the way to the end. I appreciate it. Don’t forget to give us that thumbs up and subscribe and I’ll catch you same time, same place next week. Bye for now.

Feb 26, 2025 • 1h 5min

Associate’s Journey of Growth – IC057

Not quite happy or set with being a GDP? Have you just started as a GDP and want to streamline your learnings for a brighter future? Is an MSc the right plan of action for you? How important are mentors in all of this? In this episode we discuss Dr Kiran Shakla’s journey from University to Australia to working as a Dentist at a Specialist Practice. She shares with us her top tips on how Dentists can make the most of their weekly schedules and reduce stress while dealing with different cases. https://youtu.be/IiecXSpsJmc Watch IC057 on Youtube Key Takeaways: Hard work and determination are key to success in dentistry. Work-life balance is crucial for long-term satisfaction in dentistry. The first ten years post-graduation are vital for career development. General dentistry can be fulfilling without the need for specialization. It’s important to recognize when to refer patients to specialists. Kiran emphasizes the value of personal growth and continuous learning.. Finding joy in everyday practice is essential for a sustainable career. Australia taught me valuable skills in private practice. Private dentistry focuses more on patient care than money. Communication is crucial for patient satisfaction. Finding mentorship can be challenging but essential. Shadowing experienced professionals enhances learning. Balancing work and education requires sacrifices. Need to Read it? Check out the Full Episode Transcript below! Highlight of this episode: 02:34 Introduction to Dr Kiran Shankla 06:18 Correlation between Uni and the Real World 07:29 Selling a Dream 10:13 Going Hard Early 12:43 Taking Work Home 14:55 General Dentistry 20:48 Kiran’s Journey 24:23 What did the experience teach Kiran? 31:33 Mentoring 34:38 Work Schedule 37:38 Bone to pick with Master’s 43:33 Orthodontic Position 48:53 Working with Nurses 54:33 Networking 56:33 Wrapping Up Connect with Dr. Kiran on Instagram! This is a non-clinical episode without CPD. For CPD or CE credits, visit the Protrusive Guidance app—hundreds of hours and mini-courses await! If you liked this episode, check out: Stress in Dentistry 2024 – Life Changing Decisions – IC048 Click below for full episode transcript: Teaser: They don't have the clinical skill, but they've seen so many people do it, they know what works and what doesn't. And if you get on with them and if they can teach you something, it's like going on a course and someone, I could have paid to go on a course for someone to teach me how to do that. Well, why would I, when my nurse has seen it done a hundred times and she's like, Kiran, this is how it's done. Come on, I'll help you. Teaser:If anyone stops saying, I don’t know which course to do. This is another course you can create. And you know, often, it’s a secret. It can be free. Often it can be free because there’s so many lovely people out there that are willing to say, you know what, if you want to shadow me 12 times in a year on this, like, once a month, I’m happy. You don’t have to pay me anything yet. Some people will charge and that’s okay. That’s worth it too. But if it’s free, wow. And if even if it’s charged, it’s still worth it because to be able to shadow you learn so much. Jaz’s Introduction:Being a general dentist is the toughest gig in dentistry. You have to literally be good and know everything. In this episode I’m joined by Dr Kiran Shakla, a general dentist just like me, and we talk about her journey. I feel there’s so much we can learn when we dissect an individual’s journey. And Kiran’s mindset is really quite special. It’s really going to inspire anyone who’s in the early stages of their career. Or even if you’re established in your career but you’re not quite happy, you’re not quite settled, you have that itchy foot like Kiran had, then this episode will be really helpful to you. You see, Kiran takes massive action. She moved to Australia all by herself in the middle of nowhere near the outback. And then when she came back to the UK, she wasn’t quite satisfied. She wanted more, so she did a masters. Now, we discussed in the episode whether a master’s is the right thing to do or not. I have a bone to pick with MSCs. I feel as though there are other ways to gain knowledge or achieve where you want to be in your career without doing an MSC, but it’s great to learn about Kiran’s MSC and how it opened up opportunities and network for her. We talk about themes of finding the right practice, of mentors, and how lucky she was to have really great mentors. And if you haven’t got great mentors in your life, how to find them. A really simple trick that me and Kiran talk about about halfway in this episode to make sure that you regain control of your life and your career. How to force some degree of mentorship in your life. We talk about that. And at the end, we have this wonderful exchange where Kiran tells me about her super nurse or super DA that she had and how Kiran was humble enough to learn from the assistant. Hello, Protruserati, I’m Jaz Gulati, and welcome back to your favorite dental podcast. This is an Interference Cast, a nonclinical episode. It’s got so much about communication and mindset and decision making and how you mold your career. Essentially, if there’s one thing you take away from this episode is have a vision, have a goal and bloody go and get it. Hope you enjoy, and I’ll catch you in the outro. Main Episode:Dr. Kiran Shakla, welcome to the Protrusive Dental Podcast. How are you? [Kiran]Yeah, I’m really good. Thank you, Jaz, and thank you so much for having me on here. I really hope today we’ll provide some insight to all dentists of all different ages, and hopefully when people look back on their career, or they look at what they do on a day-to-day basis, they can look at it in a more positive light and reflect on it positively. [Jaz]You have a journey and we’re talking every time I see you at one of the BDA events, and I learned about what you’re up to. And you told me an interesting thing about how about you’re working in an orthodontic practice, and you managed to get a gig where you’re doing all that restorative work. And I said, wow, Kiran, that’s amazing. How did you even land that? And so, there’s so much to learn about an individual’s journey. Some of the best episodes we’ve had in the podcast interference cast is just learning about an individual’s journey. Not that yours is the only way, but having your way exposed on the table with all the frailties or the good bits, the bad bits, the warts and all, if you don’t mind, it’s really going to help a lot of people. And I’m sure you get loads of dentists coming up to you asking, okay, well, how did you get to where you are today in terms of the current work mechanics? I guess we have to start at the beginning, Kiran, tell us about yourself. [Kiran]Yeah, definitely. I mean, it’s strange that you say that because I don’t see myself any different to any other dentist. I just think I’m a normal dentist. Just go to work, live life the way you want. And so, I guess my journey started probably when I was 16 when I got my GCSEs results and never wanted to do dentistry. Didn’t know anything about dentistry. My sister’s a year older than me, so she was going to apply for medicine. We always knew that. And I’m middle child. So, parents like, okay, this one we’ve got to keep control of. And I got my GCSEs results and it just happened. A family friend who’s a dentist just called to see how I done. She said, oh, Kiran, hey, how have you done? And I said, oh, actually I did a lot better than I was predicted. I ended up with all A’s and she was like, oh, why don’t you do dentistry? Great for females. You can work part time, you can travel. I thought, okay, great. This is what I’m going to do. And I remember I came home, and I told my parents a few days later, like, okay, I think I’m going to become a dentist. I had to go to school. I had to change all my A level subjects because I’d applied for all like IT and business studies. It changed all sciences, even to the day Jaz, my dad, I saw him last week and I was talking to him, and he still says, I still can’t believe you’re a dentist because we thought you were going to do dentist IT. This is like 11 years graduated now. So, and I guess the thing with me is once I want to do something, I will try and do everything I can in my power to make it happen. So I’m not someone who was born smart. I had to study. So, once I decided I wanted to do dentistry, most afternoons, evenings, I was studying, just studying, studying, studying. And even through dental school, like had five years at Birmingham Dental University was fantastic. I really, really enjoyed it, but I was studying a lot because I know I’m not naturally smart, but I always said to myself, if you work hard and if you’re driven enough, it will happen. What’s there to stop you? What are the barriers? And I think that goes for dentistry now as a profession, like if you want something enough and if you knock on enough people’s doors and if you do all the right things, eventually it will happen. It might not happen on day one. It might take like five years to get there, five months to get there, but it will happen because you just need to believe in yourself because no one’s going to do that for you. You can have a great support network and great family and friends, but at the end of the day, what goes on up here is what’s going to control you. And I thought- [Jaz]Two questions on the back of that, Kiran, if you don’t mind, just two questions on the back of that is number one reflection actually is that, yes, totally you have to carve your own path and you have to do it your way. But then that thing about you feel as though that you had to work hard because maybe you didn’t think that your educational prowess maybe was that a level of, so you feel as though you had to compensate, right? But, how much of a hard each individual works, the results, the marks that you get at dental school, has it been your experience and observation that there is zero correlation between how well you do at dental school and then what ends up being after you qualify? [Kiran]Oh yeah, definitely. I mean, there were some exams I was just passing, like 51, 52%. But that doesn’t matter, because it was a pass, right? That’s all that matters. It’s like a tick box exercise. Get the GCSEs to do A levels. Tick. Get the A levels to get into dentistry. Tick. Get your degree in dentistry to get a job. Tick. Because now, no one is ever going to ask you, what did you get at your, what did you pass with, or anything like that. And I think people focus too much sometimes on the, like, educational side and maybe not so more on the soft build, like communication. [Jaz]But emotional intelligence. [Kiran]Talking to people. Exactly, yeah. Emotional intelligence. [Jaz]And I wanted to mention that Kiran, is because students listen and I just, like, it’s a weird one. It’s a double-edged sword because I want them to work hard at school. I want them to do the best they can. But I don’t want them to think that when it, you know, if they don’t get like 95% and then there’s people around them getting like 80s and 90s and they’re feeling like, oh my God, when I do my 54 here, like don’t think for a second that that’s going to determine your success after dental school. That’s the message I want to send out. And I’m glad you agree with that. I’m glad you were living an example of that. And the other thing is that, that family friend dentist that called you when you got your results, she sold you a dream, the dream that she told you was a dentist is great for females. You can work part times, go travel. Are you working part time? Are you traveling? Do you think this prophecy came true? [Kiran]Yeah, I would, now that I’m in some night practices, I’ve got stability. It happened, like what she said, it’s exactly what she said it would be. Like, so this is my, everyone has their reason why they work hard, why they go to work and everything. So, for my twenties, it was to travel. Like I’ve been very, very fortunate. I was brought up traveling with my parents and after I graduated, always once or twice a year, I’d always go somewhere. I’ve seen like all the wonders of the world. I’ve climbed the top of Mount Kilimanjaro, like I’ve done a lot of backpacking holidays. So, for me, that’s fulfilled. That point is fulfilled. And even with the part time, it’s very, very difficult because in dentistry, like you can work as much as you want or as little as you want. And sometimes there’s other external pressures, which might say, okay, you need to work a little bit more. So, you might go get that five day a week job, six day a week job. I’ve noticed when I’ve done that in the past, I end up not liking work. I get really tired, I get frustrated because you’re constantly working, you’re constantly, you’re mentally always thinking on the dough, like when you’re working as a dentist, there’s not one point where you think, oh, I can just sit here and relax. You’re always having to think. And so I think a lot of what time, what happens is, especially when you’re early graduating, is you do those jobs five, six days a week because you think that’s what you should do. And you actually end up more stressed, more burnt out, just feeling tired. And then you don’t like the job, it becomes disinteresting. Whereas if you can go to three or four days a week, I think it gives you, you spend that one day a week just doing something non clinical, just something you like. Whatever it is, like you were saying, you enjoy your long drive for the podcasting. Since COVID, I’ve actually really enjoyed walking. Because it gives you the time to listen to my podcast. So, like on a Wednesday, it’s my day off. So, I’ll go pilates in the morning. Then after lunch, I’ll go for a little walk, just listen to my podcast. And it’s those little things that help you enjoy your every day-to-day profession. And so, I’d always say to younger dentists, don’t do five days a week. [Jaz]I agree. Don’t do five days. Don’t do six. I agree that. But on the flip side, playing devil’s advocate here, you need to get the reps in. And so, I think sometimes, while you’re young, child free, when you have that energy and you’re like a sponge, you’re learning, sometimes it’s more difficult to do it in your thirties, forties and fifties, but if you’re in your twenties and early thirties, and to be able to do it like that, then it’s maybe okay. As long as you feel as though you can manage it, right? It’s like individual how they manage it because then they get their reps in, they get their 10, 000 hours in and then they’re able to position where they’re carefully able to then pick, have more power to pick, okay, which days can I do? How can I consolidate my time? Do you think there’s an argument there to be had? [Kiran]Oh, definitely. I would probably say the first 10 years after you graduate are the most important because that’s when you’ll, like you said, most people are child free, you might not have any dependence on you, you may not even be married, so life is all about you, what you want to do. And if in those first 10 years you can meet the right people, maybe go on the right courses, if you want to specialize, do that within the first 10 years. Yeah, like you need to put the hours in, right? Without you putting the hours in, you’re not going to be able to get to that point in your mid-thirties or forties where you can work those left hours. So, if like anything, anything which you learn new, that’s new to you, you’re always going to have to put the hours in. But then you’re younger, you don’t have back problems, you don’t have neck problems, you don’t have like other things going on in life. So yeah, definitely the first 10 years, put the effort in, try and figure out your future, what you want to, like, where you see yourself and then how you need to work backwards from there. So whether, if you want to become a perio specialist, I think, great, how do you become a specialist? Who do you need to talk to? Which university do you want to apply? How much is it going to cost? And then you sort of work backwards from there. And you put everything in line so that you can get to that path. But yeah, I mean, hard work is always going to win over anything else. Hard work, determination, that’s always going to win over anything else. If you can believe it, and if you work hard for it, it will happen. [Jaz]Well, you’re in a situation now where you are working a bit more part time and you’re able to travel, which is what you are promised. The prophecy was promised and you’re living now, which is great, but it doesn’t come by accident. You had to work at it. And so what we’re going to unpack today is what were the struggles you had? How many frogs did you have to kiss before you found the prince charming positions, if you’d like, as I like to say on the podcast. But one thing I remember is I was in like, third- or fourth-year dental school. And I picked up like this magazine that you might’ve heard me say this podcast is probably the second or third time mentioning over the hundreds of episodes in the last five, six years. I saw this fifth year dentist. She was like, it was under her like a dental ball, like, leaving ball, right? It was like, I am really excited to qualify. And I love the fact that I’ll be able to go to work. And come back and I can switch off because dentistry is done when I come home. And she said that, and I was like, Oh, that’s interesting. Yeah. It’s a good way to think about it. You can’t be in someone’s mouth when you’re at home. Therefore, when you come home, it’s off. That was the biggest lie ever. That was for me the biggest lie ever, because how can you be a comprehensive dentist? If you’re not constantly looking at your clinchecks, you look at the STL files, you’re speaking to your technician. You’re writing letters to your patients, you are really just sometimes sit down and thinking, hmm, how can I solve this patient’s problem? And then communicating that to them? Do you find that as well? [Kiran]Oh, yeah, definitely. And if you think maybe like 20 years ago, where they were clear aligners is not a big thing. FGL files didn’t exist. It was all analog. You could probably argue at that point, most dentists could just go home and switch off. And especially if you’re in a practice where patients aren’t used to you sending them letters or you’re sending them loom videos or anything. You could probably say that actually, yeah, and even now, if you just work as a general dentist, you don’t do any, like, ortho, you don’t do any complex cases, just your basic dentistry. Potentially, once you’re confident with your level that you’re applying clinically. That is something that you could all be, actually, if you do want that lifestyle, it is there for you. But most people now, I think, especially younger dentists, because they’re seeing social media, they’re seeing all these different new ways of doing dentistry, and they probably think that’s what they have to do. I think there’s two arguments in there. You can just be the general dentist to just general dentistry and there’s nothing wrong with that. In fact, those people probably have the more chilled lifestyle because they don’t need to write their own. [Jaz]They are some of the happiest dentists I meet. They work three days a week, they have their other hobbies and interests. They do mostly single tooth dentistry and that’s okay. The crown here, the filling here, a couple of restorations here, extractions, a good service to their patients. They have a real good relationship with their patients. They make good money. They could do more if they’re more comprehensive, but they’re happy, right? They’re happy in life. And there is something to be said about that. Please don’t think there’s podcasts. And what we’re going to saying is always have to constantly grind and constantly have to be doing full mouth rehabs. That is so far from the truth guys. And I’m so glad you mentioned this, that it’s totally okay to, as long as you pick it, because the worst thing to be is you want it to be. The comprehensive dentist, you want to treat tooth wear cases, you wanted to have more fun in whatever that means for you, but you are stuck or you feel like you’re in these shackles, right? And so that will be living a lie. But if you truly wanted that, you know what? I want a more chilled pace of work and I’m happy with that. Then you are living the dream. [Kiran]Exactly. So that’s for me. It comes down to you as an individual. And in those first 10 years, if you just think, okay, I actually just want to be a general dentist, then just do what you need to, to become a really good general dentist. [Jaz]The toughest gig in the world, by the way. Just a general dentist. It’s like saying just a housewife. Like it’s tough. It’s toughest gig in the world, right? It is one of those that, you have to be mom and housekeeper, that kind of stuff. So it’s nothing like, yeah, I know what you mean, but totally like what we do is the toughest gig. Are you still general, like in sense, like here in like, do you do everything? I’d love to know before we go deeper into your choreological journey, do you do everything? Because there’s a concept I’m working with called niche kebab and niche kebab means for everything, every new skill that you pick up. What are you going to give up? Right? And so when you tell me your journey, just tell me more about, did you start to niche? And did that mean that you were giving up certain procedures? [Kiran]No, so I am a general dentist. So if you ask me, what was your specialty? I don’t have one. I am actually a general dentist. And part of my growth was, all I wanted to do was to become really good at general dentistry. Like, I wanted to do a really good class 2 posterior filling. For some people they’ll be like, oh that’s so easy, but for me it was a challenge, right? Like, to do it nicely, put your rubber dam on, do your sectional matrices, etc, etc. It takes time to gain that skill. And even the other day I was reflecting, it used to take maybe like an hour and, like, maybe 5 years ago, an hour and 20 minutes to do a class 2 filling. And now it takes 45 minutes, so, but for me, that’s the win because I’ve always wanted to do it, follow the right steps, but I’m getting quicker at it, and then, so if you say to me, what are you, so I’m a general dentist, yes, I do a little bit of ortho, not loads, yes, I do a bit of composite bonding, not loads, at the end of the day, I don’t want the stress of constantly doing clinchecks, constantly writing letters, like, I got masters in restorative dentistry, so yeah, there are times where I will do full mouth rehab, tooth wear cases, but also, I’m not catering them. I’m not looking for them. If the patient walks in and they need that, fantastic. If they just need general dentistry, that’s okay. And I wouldn’t say I’m a single tooth dentist. I do look at the mouth as the whole. But I’m quite happy with that because it allows me to live the life that I want to. It means I’m not stressed out all the time after work. I’m not chasing up labs with anything like that. And also, I think there’s a lot to be said for being a general dentist. Like, but there’s still things I can’t do very well. Like, I find some extractions really difficult. If it’s like root filled and brittle. And there was a period of time where I would give it a go. I’d try and get better and better. And it makes you realise, hey, you’re just not good at this. So, do the extractions you can. And if it’s complicated, just refer them. Like, what’s the big deal? Like, there’s someone who’s better than you. The patient is going to have a better experience. The dentist who’s doing it is going to enjoy doing it. But also for me, that stress of like spending like 45 minutes trying to take out a tooth that doesn’t come out. I could be doing a Class 2 filling, which is what I know I’m good at. Same again, the root canals, like primary root canals, if they’re quite straightforward, I’m happy to do. But equally, there’s endodontists in the practices who love that. That’s what all they do, day in and day out. So, there was a time where I worked in one practice and my principal loved root canal. And so I would take on more challenging cases because he was there helping me. Like if something went wrong, he would pop in and be, Oh, okay, let me have, have a look and help you. But also I just, it was stressful. We’re trying to take all these sand skaters. So what’s wrong in saying to someone, actually, you know what, there’s someone better than me in the practice. They only charge a little bit more. Go and see them. And you’re still going to come back to me for the crown anyway. So, I’m a general dentist. [Jaz]And I love that. But two reflections there. One is cherry picking. Like there’s so much crap you have to deal with as general dentist and such a difficult job. Therefore, one of the good things going for us is the ability to cherry pick to pick the low hanging fruit, okay, and feed the specialist because they need to eat as well. Right. And so, sometimes it’s not the procedure. Sometimes it’s the patient. And specialists hate this, specialist hate it when they hear this, right? Sometimes it’s not the procedure. Sometimes it’s the patient that that’s being referred. And that’s why you specialists, you have to deal with the tough patients and the tough procedures. That’s okay. Suck it up by the cup. That’s what you picked. So that’s fine. And there’s a beauty in just making peace with the fact that, okay, this is all the things I do. These are things I will do to a certain complexity and I’ll refer that. But the other thing is like, it’s good to do some things that are a little bit tricky now and again. And I like what you have is very similar to what I have whereby if a comprehensive care patient walks in, right. And I love that, but I don’t want my diary like full of that. Cause sometimes it’s really nice with not getting enough sleep, sometimes with the kids and everything that happens around the scenes, you go in. And you’ve got, even though my receptionist know I hate the checkup days, checkup days, right? It’s a stable list of patients. It’s a nice to catch up with my patients. It’s very sweet to just learn about this. One of the beautiful things about being a dentist compared to a GP is that relationship that you can build with your patient. And so sometimes the checkup day, some basic dentistry that I can literally do with my eyes closed. But it’s okay because now there’s other things that could be taking my energy and my time. Whereas when that comprehensive care patient comes in and that excites you, then that keeps you going basically. But as Ian Buckle taught me many years ago in the Dawson Academy, do you really want your list full of three or four comprehensive care patients a week? Like literally the amount of time you’d have to spend out of clinic and actually thinking time and how many things that could go wrong is often something that we think we’d like the idea of that. But it’s something that actually can go quite south very quickly. [Kiran]Yeah, I would 100% agree, like, recently at work I’ve had probably four comprehensive patients that I’ve walked in for just checkups. And I’ve actually had to say to them, look, I actually need to take some time, I need to think about this, and I have to write you a treatment plan letter because it’s not a straightforward treatment. But that takes time, like, that might take an hour to two hours of my personal time to write out. And then you have to link the treatment with all the specialists. Okay, you need some root canals redone, go to the specialist and come and see me. I’ll prepare the teeth for crowns, or you need implants, you need ortho, you need tooth wear. And there’s nothing wrong with that. Like, I really enjoy it. But I would not want to be doing that every week. Like, maybe once or twice a month. Amazing. But the rest of the time, it’s like you say, you want to just go in, do good dentistry, make your life as easy as possible, and refer when you need to. [Jaz]Lovely. Well, I’m loving the direction it’s gone already. So Kiran, let’s actually go with your journey, right? So you’re at Birmingham, you had to work really hard. You’re out in the real world now. You had these visions and ideas of way you wanted to be, i. e. in the direction you are in now, but was it a smooth journey? Did you have any challenges? How did you navigate your first few years and just share your journey with us? [Kiran]Yes, I think the first few years when you graduate, life can be a little bit different to how you pictured. So I did my FD training in a practice in Slough and it was a fantastic experience because you saw so many patients, they needed so many different things. And it was great. And then the year after that, I applied for more training because I thought, maybe I’m not at that level where I think I can go into practice. So I got another training job and that used to be 140 mile commute every day around Frick from where I live. [Jaz]How long would that take? Like the whole day? [Kiran]I would start work at 8 and I’d leave at 6. 40 and I’d get there like 10 to 8. But the beauty of all, there was no traffic at that time. So it’d be straight down the M40, literally 50 miles down the M40 and 10 miles here and there. And same again, that, my trainer there was a endodontist. So I had a trainer who was an endodontist and a regular SD1 trainer. And so I learned more about endo that year. So it got me used to doing a bit more endo with hand files and everything, but a little bit like yourself, I actually wanted to move abroad. So when I was in sort of fourth, fifth year of university, my dream at that point was to move to Australia. And so after this second year of training, I actually got a job out in Australia in Queensland, but it wasn’t in any of the cities. It was quite far away. It was eight hours north of Brisbane by car. So I got a sponsored visa and in summer of 2015, I flew out to Australia by myself. And I started working out there in private practice and it was nice. There was like a group of expert dentists who were all from the UK who were there. It was a lot slower pace dentistry. The weather was good. And after six months after setting there, what I realized was that, okay, I actually want to get better at dentistry because at that time, I didn’t think I was very good. And I would have to fly everywhere for all the courses. So, just to go for a course for a weekend, you’d have to fly down to Brisbane or fly down to Sydney. And then you spend a couple of days there, then I’d come back and then you’d have to implement it. And also where I was located, because it was so in the outback, I was 25 at the time, and I was thinking, this is not the place to be for a 25 year old, like, especially where I live now, it’s so close to London, it’s so close to the airport and everything. So after a year, I was really missing home. I got quite homesick. And my sister, she nailed it on the head for me. She was like, you used to commute 140 miles a day and you were happy. As you know, you commute 10 minutes a day and you’re not happy. And she said, just come home. She’s like, what’s wrong with coming home? And obviously in my head, I told myself, I’m going to Australia. I’m living there for the foreseeable future. And then she was like, why don’t you just come out? And I said, no, but I had this vision, I wanted to stay out here forever. And she said, it’s okay, you might have opportunities. And you might think, this is how I want life to be, but sometimes it doesn’t happen. So, when I was out there, there was a job going on the BDJ, and I skyped interviewed for it. And it was a maternity position, but it was close to home. So I thought, actually, let me come home for a bit, do this job, see how I feel. [Jaz]Can I pause you there and ask about Australia a little bit? [Kiran]Yeah, yeah, of course you can. [Jaz]Did you see any giant spiders? I just really want to know, did you see any big spiders? [Kiran]I saw some big spiders and only saw one snake when I was out there. [Jaz]Okay, had to get that out of my system because when people say outback and that’s what you think. But okay, so what did you learn? What did Australia, because for me, Singapore, when I went to Singapore, it was my first taste of private practice and it gave me confidence to just go for it. Go for it. Now take that leap of faith. Made me brave. Made me just charge fee per item, which wasn’t used to here in the UK. And so, it gave me that sort of communication skill. I also learned how to remove wisdom teeth when I was in Singapore. Cause if you weren’t removing wisdom teeth, the dentistry didn’t pay well in Singapore. So I had to learn to be able to pay the bills. And I was like, Oh, wow, I actually quite enjoy this. Quite good. So that was that. And then just having the time, cause it’s a slower pace, take a lot more photos. Be more comprehensive, do lots of online courses while I was there as well, and just courses around Singapore. So that’s what I gained. How did you find your year in Australia? How did you grow? [Kiran]So I found that obviously with private dentistry, the patients know what they’re paying for. So never had to have that difficult conversation. Whereas maybe the end test, you had the options of private dentistry. So that was quite nice. I also found that it was a lot more care was given to the patient. So when I first started, I observed one of the lead dentists. Just doing a checkup and a hygiene appointment for a patient. And they went all the way to the extent they fluffed every single tooth for the patient at the end of their hygiene. And I was like, wow, I’ve never seen that before. The money isn’t a matter. It was all about the patient, giving them the good quality dentistry. And it really made you slow down, but also it sort of made me realize actually I do like dentistry now I’ve had time to slow down. And I do want to do further education, whereas sometimes if you’re in a really busy, busy practice and you’re not getting time to think, you’re just in the daily grind, you kind of lose sight and focus of what you want. But I also realized when you do work in private practice, you don’t have that influx of patients, you know, the NHS patients coming in and out, you really have to work. And that takes time. That takes a lot of time. And recently at the practice I’m at now, I’ve been building a list for a couple of years and it takes, it’s a completely different skill to walking into a practice where you have a list of patients to walking into a practice where you don’t have a list of patients. And actually your biggest skill at that point or the biggest thing you need to work on is communication. Because these new patients are coming in and they’re probably thinking, well, why should I come and see you? And so the biggest skill is communication, your emotional intelligence. It’s soft skills, it comes back all to that. Because what I realized the time has gone on, like, even though I got really good at my class 2 composite. My patients don’t care how my class 2 composite look, that’s for me. All they care about is they’re going to not be in any pain, they’re going to have a good experience, and that they’re not going to be having any issues after no sensitivity or anything like that. So it’s kind of like, you’re on this sort of like curve where you’re going up and then something will happen and you’ll be like, oh actually, the patient doesn’t even care about that. Like, all they care about is one or two things. And as long as I can do that from then, everything else is just for myself. There’s some of them that, you’ve got to go through that to realize. That pressure that you’re putting on yourself is maybe not necessarily needed. But yeah, Australia was great because it opened up private dentistry and then I Skyped for an interview here, which is in a private practice. So I came back and just started doing that a couple of days a week. And my principal at the time, he did implants and root calves. That was his sort of specialty or area of interest. [Jaz]The ying and the yang. [Kiran]Exactly. And so that was really nice because any time I struggled with root canals, he would always come in and he’d help me out. He’d be like, oh, look, the canal’s here. Or actually, yeah, don’t worry. And I think I was reading on dentists, the dentist the other day, like an associate had posted, I’ve perforated, and my patient’s really upset with me. Like, how do I deal with the situation? But I think, same again, that comes down to communication, right? If you tell your patient at the beginning, look, I’m going to do this root canal for you. I’m going to try my very, very best. But sometimes complications do happen. Like, for example, I may not find the canal. Sometimes the morphology is different. I might go in the wrong direction, cause you a little perforation. So then when it does happen, you don’t need to make a big deal out of it. You’ll be like, oh, hey, remember I told you. I, of perforations. Well, there’s one there. I fixed it for you. But actually, this root canal is more difficult than I would initially anticipated. So why don’t we get you in to see the specialist? There’s no charge from me today and they’ll see you and they’ve got a microscope, and they can deal with it. And even this year, like earlier this year, I couldn’t find, one of my long-standing patients and I couldn’t find a canal on the tooth. And I said to him, look, I told him before, look, these are some of the risks. And then I tried looking for, I couldn’t find it. And I thought, you know what? Why spend another half an hour on me drilling like here, there, everywhere, trying to find this canal? Just stop, just temporize it and just tell her, look, I couldn’t find the canal, but I’m going to get you booked in with one of the specialists. There’s no charge for me today. And then got him booked in two weeks later. While he was having the treatment, I popped in just to say, oh, hey, how’s it going? And then the end of this was like, oh, Kiran, look, I found the canal. You were so close. You just had to go a little bit further and had a look. And then, great. They did the root canal. I put the crown on top. Patient was happy. So I think it’s all about just communication, which is the skills, which are probably now is becoming more apparent to dentists, but historically in like the first, probably seven, eight years of my career, I didn’t think anything about communication, same again. And it was another principal who made me realize it’s all about communication. And so when we talk about mentors, I think I’ve just been very lucky. I’ve just, the practices I’ve worked in, the principals have ended up being mentors. But I think if you’re not in that situation, then what you sort of need to do is- [Jaz]Which I think most people are not in that situation, Kiran. People message me saying, oh, I was promised this job and I thought my principal would be around, but the principal’s just so busy working on the business and not in the business, the other way around people working in the business, not on the business. And then sometimes dentists become entrepreneurs and they’re trying to run the clinic and multiple clinics. And therefore they don’t have time to mentor someone. What you had was a wonderful arrangement that someone can just pop in or you could pop into that surgery and get some help. That’s a real wonderful thing. But I think it’s becoming more and more scarce, especially with dentists working part time and limited surgeries. Oh, I work on a Monday. Therefore, you work on Tuesday. Therefore, we can’t work at the same time. So where does one get mentorship? You think? Interjection:Hey guys, just Jaz interfering very timely. I just ask, where do you find mentors? Well, nowadays we have Intaglio. Intaglio is a company that I’ve co-founded and it is here to solve the mentorship crisis. I want those who want to mentor to have access to mentees. And all those hundreds and thousands of dentists who want mentors, who are desperate because they feel isolated, they feel alone, they need help, they need to solve a problem, they want to get guidance on their cases. This is exactly why we set up Intaglio. Intaglio means the inner side of a crown or denture. It also sounds like a pasta, which is why we went for the name. And the logo is a door because we’re opening doors. Imagine being able to book one hour or a 10-hour package with a mentor and maybe once a week or once a month or just a one-off session. Show them that bridge design that you’re really struggling with, or that ClinCheck or that CBCT that you just want a second pair of eyes on. The mentor gets fairly remunerated and you as a mentee get dedicated time rather than a rushed voice message on Instagram telling you what to do. There’s also a mentorship certificate that you get with the reflection. So in the future to our regulator, we can show that we are getting mentorship for certain disciplines. If you are interested in either being a mentor or a mentee or both, check out intagliomentoring.com. That’s intagliomentoring.com. I’ll put the link in the blog. Let’s get back to the main episode. [Kiran]So I think now, like you said, it’s become more scarce that I think you kind of have to think your job is your job. And that’s sort of your daily grind and if you can’t find the membership there. Then you need to do something else, which might help you find the mentorship. So it might be like, when I came back from Australia, I struggled with extractions as well. So, when I was in my VT, there was an oral surgeon who came from the local hospital to give us a call, like a one day course. Then I just contacted him. I said, hey, look, I’m back from Australia. Do you mind if I come to the hospital one day a month just to observe? And he was like, yeah, of course. He was like, come, come any time. It’s like you’re more than welcome. So if there is someone who you think, oh. They’re actually doing the sort of dentistry that I want to do, and they have no job opportunities available, but actually they seem like a nice person. This is awesome, can I just come and interview one day a week? Just to see what you’re doing, whether it’s implant, root canal, communication, anything, because surely that’s better than you just sitting in your practice every day, and you’re not getting the fulfillment that you need. So even now, one day a month at my ortho practice, the principal will come in and he’ll do all the new patient cons. And I said to him, I’m just going to sit there with you one day a month, so I’m taking a day out of my diary one month, just to see how he talks to people, just to see how he communicates, what is he doing different, that maybe I can choose, but that’s my choice, because I want to get better in that, right? So I think that’s what I’d say to young dentists, find someone, and who can maybe give you one day a month, it might mean you have to reduce your days, or you might have to change your diary or something, but if that’s really what you want to do, then, do it, basically, because no one’s going to come knocking on your door. You’ve got to knock on other people’s doors. It’s kind of like, I always give the analogy like, let’s say you open a business, you open a gardening business. Okay, so you make all your leaflet, you do your website and everything. But unless you physically go around and maybe knock on every person’s door on your street and say, Hey, I’m the new gardener and this is what I do. Who’s going to give you the time of day? So you have to put that effort in. [Jaz]100% and I think the way you learn through shadowing is so powerful and it’s something I’m really emphasizing more and more as well because the most powerful learning experience I had were either I was shadowing someone or I was rescued by someone where someone was able to physically come and help me clinically and so people do like these diploma courses where once a month they will fly somewhere and do a day of restorative or do a day of oral surgery, whatever. So lots of lots of diplomas out there now, right? And think of it as your own diploma, whereby you take a one day out to shadow someone. And if you just do that, that is just as meaningful, if not more valuable then, because you get to actually see the implementation of the knowledge that you learn, the courses, you don’t just get the knowledge you see, actually see the implementation, you see the communication. So if anyone’s stuck saying, ah, I don’t know which course to do. This is another course you can create. And often it’s a secret. It can be free. Often it can be free because there’s so many lovely people out there that are willing to say, you know what, if you want to shadow me for 12 times in a year on this, like once a month, I’m happy. You don’t have to pay me anything yet. Some people will charge and that’s okay. That’s worth it too. But if it’s free. Wow. And if even if it’s charged, it’s still worth it because to be able to shadow, you learn so much. So let’s say, let’s go back to the point where you came back, you’re working just two days a week at that point, back from Australia. Did you then extend that to more days? And how’d you navigate working in multiple clinics? Tell me more about that. [Kiran]So yeah, I was there two days a week and I was at a NHS practice two days a week. And then after this maternity cover, the principal said, okay, look, we’re going to actually build another surgery. We’re going to keep you on. So I thought, okay, great. So then I pushed up to four days a week and it was nice. The one thing my principal said to me quite early on is he’s like, Kiran, you need to have a niche or something that you’re good at, whatever it is, he was like, you choose what you want it to be. But that’s the one thing that people will know you for and they will come to you for it. So I thought, okay, so I was like, what can I do? What can I do? I don’t know. I was like, should I do MSC in Root Canal? But I was like, I don’t love Root Canal. I was like, should I go do oral surgery? I don’t love oral surgery. So I just thought, you know what, I’ll just do a master’s in restorative dentistry. And I’ll just continue down this restorative because that’s what I like, right? It’s like, I just like the steps. It’s all about the clinical skills, but it’s very repetitive as well. So once you get very good at it, you can do things in a short amount of time, but to a very high standard, so. I did my four years part time master’s at UCL Eastman and same again, the benefit of working in this practice was the principal had also done a master’s from UCL Eastman as well. She was very supportive. So anytime I had cases, I said, Oh guys, I need to find like a resin bonded bridge case. So then people would have a look, be like, okay Kiran, we’ve got this patient, great, okay, the patient comes see me, I’ll take photos, document it. But it was very nice to have that support there. And I know that’s not available, again, for all people, you know. A lot of people don’t get that with their principals. But if, let’s say, that’s the sort of master’s you want to do. Maybe have a look in your local area, see if someone has done a master’s from the same university and maybe they might be able to offer you a job one day a week or something like that. Or even like we’re saying, get the mentorship from them so that you can discuss cases with them and everything like that. So I did that four years part time while working in this one practice and it essentially finished in 2020. [Jaz]How did you find that? I mean, I’ve got a devil’s advocate to play again with a master’s, we’ll talk about that in a second. But how did you balance working four days in clinic? Plus the masters. Was that a difficult time in your career? [Kiran]Yeah. I mean, it was tough. Like most evenings I would come home and I’d be basically working upstairs. The benefits I had was I was living at home with my parents. So they would feel like Molly cuddling me and making food and doing everything for me. Which was really, really nice. I’ll always be thankful to them for that and everything else. But it is tough, but it’s also just a short period of your life, right? So you’ve got to give to get, but there’s no way I would be where I am today if I hadn’t sacrificed that time. Okay. And I still traveled. Like I still went on holiday because you still got the summer holidays and the Christmas holidays. So I still did what made me happy. And it was the sacrifice and there was a lot of evenings or weekends which I missed away to my friend and say, I can’t, I’m studying, but I don’t regret it because it helped me get to where I am today. [Jaz]Sorry, different people do masters for different reasons, right? And my bone to pick with masters, being married to someone with an MSc in paediatric dentistry, she got a distinction, she did very well at UCL, she did her Paeds, right? And so she did brilliantly and I saw how much effort she put in. And she was learning about apexification and MTA and that kind of stuff and this treatment and that treatment modality and all sorts of niche things in paediatric dentistry. Well, that’s him. How many of these procedures have you actually done? Oh yeah, no, we haven’t done any. And so my bone to pick with MSC is not necessarily your MSC and you can shed some light on that, but a lot of MSCs that implant MSCs, right? How many implants do you actually place? Oh, well actually I wrote a thesis, but either you play zero implants or you only placed a few implants. And that doesn’t mean you shouldn’t do the MSC because it gives you great grounding, allow you to critique the research. And some people just need like all the evidence and critique it to really feel confident. Okay, now I know I’m doing now. I can unleash myself to the world. So what was your expectation of the MSC? Did it meet your expectation? Do you perhaps have any regrets of the Masters and perhaps how much hands on exposure you may or may not get? [Kiran]Yeah. So I think when, and I completely get what you’re saying about the other masters. I think with the restorative masters, because it’s based at least the first two years on traditional general dentistry, doing your bridges, your crown preps, your fillings. I think you can’t go wrong with that. But equally, there are also one year courses now where you can probably learn exactly the same thing. So you don’t necessarily need to do a master’s, maybe just a one year like solid foundation restorative course. You could probably gain exactly what you wanted from it. The third year from my master’s actually did a lot of tooth wear and that’s something I really enjoy doing. So I do a few tooth wear cases, maybe one a month or something like that, but that’s something I really enjoyed. So for me, I actually benefited from that, but that’s not to say they’re not great tooth wear courses out there as well. And even though we had a tooth wear module on the MSC, I still went and did some tooth wear courses after. So I think if you’re going to go down the master’s route, you need to be very picky about why you’re doing that master’s. And that’s why I just chose the general one. I was like, it’s a general masters. [Jaz]Why did you do a master’s and not go for the one of those short courses that assemble all sorts in a year or Kostas’ injection molding course probably wasn’t around back then, basically. Like, why did you choose to go for it? And there’s lots of benefits of going for a structured pathway, like a master’s. I see that you get letters at the end. Everything is like tried and tested, all the access to papers. I appreciate that, but were you tempted? Were you in your mind thinking, hmm, should I spend this money and time doing the master’s? Or should I just do a year long course? Did that debate happen inside your head? Cause a lot of people have that debate and they present it to me. [Kiran]Yeah, I think at that time, because my principal had done a master’s from UCL Eastman, I saw how fantastic his work was and how he worked. I think for me, it was a no brainer. I think it was just like you’ve got to do a master’s and that’s what it was. It was plain and simple. And also at that time, there wasn’t as many yearlong courses. I think now there’s a lot more yearlong courses to choose from. And I think the third thing was I’ve always wanted to teach. And I thought at the time, if I had a master’s, it would just make me more representable or maybe help with the teaching. So that was another sort of reason why I was like, no, I’m going to do the master. I’m going to do the full masters, not just drop out after the diploma or certificate, because I wanted to teach. And I thought maybe this will help me as well. Whether it has or hasn’t is very difficult to say, but I guess, things happen for a reason. So on the final year of my MSc, it started January, 2020. So it was just before COVID happened. And we had one or two days of lectures. My now principal at my practice, he was actually in the year above me. But he took a year out because, for whatever reason, and he dropped down into my year. So we were just talking and we were talking and I was like, Oh, where do you work? He was like, oh, I work in Reading. I was like, oh, I live in Reading. And then that was it. We saw each other maybe over two months with everyone else. And then after that, I never saw him again because it went into COVID. But when the job came up at his practice, he messaged me saying, hey Kiran, there’s a job going, do you want it? And I honestly think I would have never got that job if I hadn’t done the masters, been there on that exact day to meet my principal for them to him say, you know, Kiran, I’ve put in a good word for you, just apply, come for the job. So everything happens for a reason, right? [Jaz]I think you’re totally right. It helps you to network as well and it gets you out. It’s like you said, it’s a small part of your career. So I think the main lesson that probably you can both agree on, I like the fact that you’re very open to the fact that you could have just done a long alternative course rather than MSC. And I really appreciate you saying that after having done MSC. Sometimes people do something. No, no, no, surely MSC. You’re very open. You’re happy to admit that actually there was alternative, other brands are available, et cetera, et cetera. But you can’t deny the fact that as long as you have some sort of focus, as long as you’re doing some sort of further education, because if you’re not there, either in your confidence or your knowledge where you want to be, then you need to take action. And what you did was that. So this could have been any course, but you channel your energy and time into something and something good came of it. So the worst thing you can do is sit still and just sit on the fence about what should I do next? How can I bet myself as long as someone takes action and speaks to enough people to think that, okay, yes, this is the right thing for me. And whether it’s not the right thing, they always say our choice is a half chance, right? If your principal did not have a master’s and maybe your principal had done some courses and say, oh yeah, do these courses, you’d be fine. Maybe you would have gone down that path. Who knows, but as long as you do something and you own it and whatever you do, you put your heart and soul into it, which I’m sure you did. Then you come out the other side smiling and you’ll have a good network and a good experience. [Kiran]Yeah, a hundred percent agree. Like, yeah, I think the people around you may help make decisions because if there’s someone you really look up to and they’re fantastic at perio, you might be like, Oh, I think I’ll do perio a bit more. So I think that definitely helps, but like you, you hit the nail on the head. Essentially, whatever you do, put your whole heart into it, just focus, knuckle down, get what you need. It’s only for a few years of your life, it’s not forever. And then after that, things will get easier. [Jaz]I just want to just home in on your orthodontic position that you said, right? So you are working in a clinic whereby it’s a specialist orthodontic clinic, but you do the restorative of that clinic. So like, spacing, peg laterals, that kind of stuff. That’s a really cool gig to have, right? Someone who is into restorative like you, you get to do the bonding, and these are patients who’ve had the pre restorative ortho. This is like the dream scenario, right? You don’t get the case where you’re having to convince the person to have ortho so you can do more predictable bonding. You’re literally getting everything set up. So you’re minimizing your occlusal risk. You’re literally having a good baseline. Tell us more about this position and then how did you find or get this position? [Kiran]So this division, it’s quite a unique one, which is why I accepted the job role. Because it was like you said, most people get general dental roles. And this one, this opportunity came to me and we’ll go through how it came to me in a moment, but I thought it’s just too good to say no to. Like, the opportunity is too good and the dentistry I do there is completely different to the dentistry I do in my regular practice because my regular practice is just the GDP, regular exam, routine recalls, whereas in the old practice I’m there for a specific reason and that is you could call it cosmetic, aesthetic, restorative side. So, this practice essentially gets a lot of self-referral. And what they were doing previously is they would turn the patient away. They said, Oh, sorry, you’re not dentally fit. Go find your own dentist and then come back for the ortho because we don’t have anyone here who can do it. And then it got bought out by one of my previous principals. And he said, no, we need someone in here to actually look after these patients so that we can get them dentally fit and then they can go off and see the orthodontist. But then equally the orthodontist will then be finishing off cases and they will say, okay, great. Like your peg latches in the right place. Here’s your Essix retainer. Now go back to your regular dentist and let them do the bonding. And then you can come back here, and we’ll give you a new Essix retainer. But sometimes the patients wouldn’t come back, sometimes the dentist’s skills were just not up to what they were hoping. And so now, we’ve got a room nurse system, we pop into each other’s rooms all the time, I’ll pop in and be like do you think that’s enough space? I’ll be like, oh, can you like put a little bit more space just there? Or weekly if a patient has come in for a new patient consult and I’m thinking, hmm, is this like clear aligner treatment? Or is it fixed braced? And I’ll call the orthodontist and I’ll be like, what do you think about this case? And they’ll be like, oh, yeah, I think you can do it, Kiran. Or actually, no, a bit more complex, send it over to me. So the denture I do there, it’s a lot of composite bonding. We’re sort of moving on to more ceramics now and veneers and everything. But it’s pushing me to get better in that area. And so one thing I do at the beginning of every year is I’ll write down on a piece of paper what I want to get back better at in my clinical profession and also my personal life. And so for a long time, it was get better at posterior composite, like posterior composite. It always be there and root canals. It always be there. And then it got to a point where I was like, Oh, I’m actually like quite happy with how I’m doing. And the next thing was I can get better at anterior composite. But it’s like you said, it’s like 10, 000 hours, unless you’re doing it regularly, you’re not going to get better at it. And so this thing and this practice is pushing me because someone’s always looking at my work. It’s not just me doing it. And then the patient goes, I’ve got an orthodontist going to be checking. I’ve got one of the therapists who will be scanning and just checking. And I always say to them, if it’s not good, you tell me, we’ll get it fixed. But it’s a really unique position. Really, really enjoying it. [Jaz]Did you get headhunted basically for it then? [Kiran]So what happened was, it was a planned practice. And it was fantastic. It was very, very busy, but I was getting quite, I guess, tired, like mentally, because he was doing 15 minute checkups, 15 minute checkups. It’s just so busy, you didn’t have time to think. And I wasn’t really enjoying it at that point. So, I was just looking online one day and then this job had come up, which was like three miles down the road. And essentially it was to work on referral from the principal dentist. So I was like, okay, cool. Like this is something different. Let’s go and try it. If it doesn’t work, I haven’t lost anything because I’m not leaving my regular job. They only want me there two days a month. So I started there and essentially what the principal would work a couple of days a week. He would treatment plan the cases and anything he thought that I could do, he would refer into me. So when I would go and I’d just have a full day full of basic treatment and anything that was a bit more complex he’d keep for himself. So I went there. And this is where I have to give a big shout out to nurses because we had the same nurse. So I remember the first day I went in and she said, okay, you’re going to do these clasps, like, you know, these buccal fillings. I thought, great. And she said, you’re going to use this instrument. I was like, well, what’s that instrument? And she’s like, don’t you know what it is? And I was like, no. And it was basically OptraSculpt. And so she was like, and I was like, so how do I use this? And then she got her hand and she got a model. She said, okay, you’ve got to use it like this and you’ve got to brush it like that. And I want to give you some like brush and sculpt on the back of your glove. You’re going to do this. I thought, okay, great. Like she’s basically told me what I need to do. And then the patient came in, we did the treatment. Then at the end, she was like, okay, Kiran, you did that good, but you could have improved here, here, and here. And I thought, okay, next time. I said, next time we’ll do that. [Jaz]Wow. [Kiran]Well, next time we did the, yeah. And this is what I mean. [Jaz]But some people can get really offended. Like I see posts all the time anonymously, whereby, Hey, I’m a dentist and I feel as though my nurse is undermining me. My assistant’s undermining me. You could have, if you wanted to, Kiran, interpret that like, Hey, who is she to tell me what to do, but I appreciate and I like the fact, maybe it’s the way that she did it, or maybe it was you being an open minded clinician, being growth mindset and being open to be like, you know what, I’m willing to learn. So do you think it could have been that you could have misinterpreted that or was her delivery, was her tact really good? [Kiran]So I think when you’re in this position, you have to think, who’s been qualified for longer in the dentistry profession, you or your nurse? And especially when you’re starting out, your nurse, they’ve worked with so many different dentists. They’ve seen so many different things. They know what works and what doesn’t work. So sometimes, like, you just have to ask, even now, I still work with that same nurse, and we were doing a veneer prep case a few months ago and I said, okay, run me through what the boss does and she was like, okay, he does it like this, he does it like that. And then on that day I said to the practice manager, please, can she be with me? I want her to be in the surgery, like assisting me. And she helped me out. She was like, oh, Kiran, like you’ve just missed this bit or like drop the margin a little bit, or even when we do composite bonding, I always say to my nurse, what does it look like? How’s it looking from your side? Because from my side, it looks okay. And then both, all my nurses are trained now to actually tell me, oh, Kiran, you missed a bit, or it’s looking a bit high here. You need to polish that back. But I think with this nurse, she was quite like confident. She was like, I’m going to tell you how it’s done. And at that time, I wasn’t the most confident dentist, so I kind of took it on board. But like, what you said with these anonymous posts and stuff, don’t feel afraid. These nurses have more like, they don’t have the clinical skill, but they’ve seen so many people do it. They know what works and what doesn’t. And if you get on with them, and if they can teach you something, it’s like going on a course, and someone, I could have paid to go on a course for someone to teach me how to do that, but why would I when my nurse has seen it done a hundred times and she’s like Kiran this is how it’s done, come on I’ll help you. If they’re willing to help you, like it’s like another mentor, right? Just because they’re a different job title to do doesn’t mean that you should see them any different. You’re a team, you work together. And I love it. Like, I really like working with this nurse and she’s now going to go on to become an orthodontist therapist. So I’m really, really happy for her that she’s excelling in her career and everything. [Jaz]And she deserves it. You can tell, like, this is not your average nurse, right? She is a go getter. She’s obviously very proactive and she’s not like a passer by looking at the clock waiting for lunchtime. She wants to have an active role and how wonderful that you had that experience. And how wonderful you were so nice about it to actually be receptive and willing to learn. Although, whereas other colleagues may be offended by that, I salute you. I think that’s wonderful. [Kiran]Yeah, exactly. And then she would learn stuff from me. And then she would go back and tell the principal and he’d be like, how’d you know that? And she’s like, oh, Kiran taught me. So it was like a two-way thing, like she was teaching me, but then I was teaching her, she really likes learning and then she was going back and teaching the principal. And I think that’s when I started realizing, and even the principal and she was like, actually, you are very good at your posterior dentistry is just, you need to get that confidence now. And so that’s really where it started growing. I got the confidence. It was good to have that feedback because when you work on referral, essentially the principal is the responsible, right? So if something goes wrong, they want to make sure that you’re looking after their patients, you’re treating them well. So he would always get feedback from the patients. Or he would review my work, oh Kiran that was good, but you could have improved there or etc, etc. So I learned all of that and that was a very niche position. The same again, I applied for it, got the part. If I hadn’t applied, I would have never known about it. He took sort of the gamble, like I’ll reduce one day or two days a month at my regular practice to try it. And I started enjoying it more and then we picked up to every Friday. And then he, as he trusted me more, he let, started letting me do bigger cases. And then I still remember the first time I did my anterior composite bonding, because I hadn’t done much of it. So same again, he had got the wax ups made, and the nurse was like, okay, Kiran, you’re going to do this. You’re going to do that. And the result was okay. Like I look back on that result and I think, oh, that was really not that great. But then he followed up with the patient, it was booked in and then he polished it. And then he said to me, I’ll book her. And next time you actually just need to polish a little bit more and get the shapes a little bit better. And he took some photos and I thought, okay, great. And then I thought, okay, I need to get better at that. So let me go on a course for that. So then I came back and I learned a few tips and then my nurse was like, what are you doing now? And I said, Oh, like this is opaquer, it helps with the joint line. She’s like, Oh, that’s so smart. I’m going to go to, so it was a great relationship and it really helped build the confidence and unfortunately what happened was that principal, he was a partner in that practice, so he sold his share and he bought the ortho practice at the same time. So that’s how he said to me, he had always said to me, but at some point. There will be a position there for you. I just need a year to get it going. And then you’re going to come in as the lead restorative dentist. So in the back of my head, I always knew that that would happen, but it was great because then it pushed me even more because now I work with a team of orthodontists. [Jaz]But you have the MSC already at this point? Did you have the masters already under your belt? Right? [Kiran]Yep. This is like 2021 onwards, essentially. So I had the masters. [Jaz]And that gave you validation that gave you confidence for application. That gave you, had you not had the masters, maybe you would not have felt worthy to apply. I don’t know. I’m just making that up. I’m just, you tell me. [Kiran]Yeah. I mean, it potentially, yes, like it could have been that way. And I always felt like my written CV would get me through the door, like, because it’s like, okay, you got a masters, you got this, you got that. But when it came to the interview, it was all about how I presented myself, the communication, like. Because once someone knows you, all they want to know is that you’re a nice person and you’re not going to do any crazy dentistry. You’re just going to be nice dentistry, good dentistry, keep the patients happy, keep the staff happy. And so for me, I think it was for myself and I’m not saying everyone has to get a master’s. You don’t even have to go on a course. But for me, especially as a young dentist, I felt like it gives you that tick box. Okay. Yeah, cool. Like tick box. She’s got the master. She’s worked in a few nice practices. Okay. She must be okay. Let’s interview her and see what she’s like, basically. But I think, a lot of people, you need to network. I think that really, really helps. So like, I’m part of the BDA Reading Committee, and I know you’ve come along to some of the lectures. But the best jobs you will get is through networking, and I think there’s not enough emphasis on that. So yes, I could have had my master’s in everything, but would it have maybe led me to the positions I’m in today? Probably not. Because one of them I got just through networking. So, I think you need to go, if you want to stay in your local area, you need to go meet local dentists. Whether it’s at your BDA events, or if some practices do study clubs. Go in there, meet the dentist, meet the principal, get to know them, because at some point someone will say to you, hey, Kiran, we’ve got a job going. Are you interested? Because they know you’re a nice person. They probably know your dentistry is good. That’s why you come into all these study clubs. And that’s what’s going to open doors for you. I still remember once, when I was leaving my NHS job before the plan practice got really busy, I was sitting on the table with one of the other committee members and he said, Oh, what are you up to these days, Kiran? I said, I’m working between two practices, but I’m not really sure about one of the practices. And he said, Oh, we’ve got a job going at our practice. Why don’t you come and work there? He said, I’ll put in a good word with you for the principal. I thought, okay, great. So he said, Google us. I Googled and then the principal. He invited me. He said, yeah, I’ve heard good stuff about you. This is the surgery. Do you like it? When can you start? And that was it. He didn’t even want to see my CV. [Jaz]I hear this all the time, Kiran. [Kiran]I know you’re a good person. [Jaz]I hear this all the time. You’re so right. Here’s your network. So I think, I’m shocked sometimes when I go to these BDA events, when I go to other study clubs. And the low turnout shocks me, like not that they’re super low because you guys run BDA and Reading really well in particular, but other ones where there’s only five or six people or 10 people where in the local area, there’s hundreds of dentists. So especially young colleagues. Yes, we see a few, but where are you guys? You guys are complaining that there’s no good jobs. You guys want to be able to network, but these very low-ticket offers are there to go to these little study clubs or even free study clubs sometimes. Where are you? So make this a lesson to start shadowing people, start attending your local events, be inspired by your journey and your path. We’re out of time now, Kiran, but any last thing you want to say before we wrap up? [Kiran]I thought mainly like, just be happy. We’re in a very fortunate position. I know some days it feels like we’re not, but when you look at the general population of the UK and you see the struggles that everything, everyone goes through, just think, I’m lucky to have this job. I think also just practice being grateful because we don’t do that enough. But if like now, if sometimes I sit there thinking, oh, what am I doing? But then I’ll have a look at a few photos or I’ll look through things. I’m like, actually, I’ve done all this. Like I forgot about that. A lot of time as humans, we focus on the negatives, like always just talking about negative negatives, but actually the positives you forget so quickly, like you forgot you did this amazing thing. So always reflect, take the time once or twice a year to write down what you want to do, but also reflect on where you are, how far you’ve come, like if you had told me three years ago, I would have been like lecturing internationally, I would be like, no way, but. Like that happened this year for the first time and it’s nice to see the hard work, the drive does pay off. And overall, like your dentistry is great, but it’s just a profession at the end of the day. It’s not who you are. It doesn’t define you as a person. It’s just one part of your life. So have other things in your life to keep you going, keep you happy, keep you motivated. And yeah, just find good mentors. I’m always here if people want to reach out or anything like that. Just drop a message. [Jaz]Tell us your Instagram because I want people to follow you and speak to you and tell you what wonderful job you’ve done this episode. What is your Instagram? How can they follow you? [Kiran]So my Instagram is @shanklasmiles, S H A N K L A. Even though I’m married, I don’t think I’ll ever change that surname because it’s part of me now. And yeah, just send me an Instagram message. It’s very easy for me to get in contact with you or anything like that. [Jaz]Well, thanks for sharing your journey, vulnerability, your decision making, the decisions that you make, and I’m so glad it worked out well for you. But I think it’s because of you, just the interaction that you have with that nurse, for example, just speaks volumes about you being open and receptive. And I really appreciate you sharing your journey. I also just want to add that, you know, there’s a lot of doom and gloom and to be positive, like you said, but one of the best things that I did is I stopped watching the news. I just don’t watch the news anymore because the news is just depressing, negative headlines sell that kind of stuff. And in a similar vein, a lot of these Facebook groups that are there and everything is constantly about litigation and patient complaints. And my principles reduce my percentage or whatever, like a principal versus associate war. And so I often think that a lot of these groups are also becoming quite toxic and quite negative. And so it’s nice to sometimes switch off from that. And if you want to join Protrusive Guidance, I just want to give a plug here for the nicest and geekiest community of dentists in the world. I think everyone should look for other areas where people are a bit more like minded, a bit more positive, just like you are, Kiran. So, Kiran, thanks so much for giving your time up to Protruserati. You’ve inspired hundreds if not thousands, so I appreciate that. I think it’s really nice to learn about someone’s journey and I’m proud of you to see what you’ve done so far and onwards and upwards and see you at the next BDA event, I’m sure. [Kiran]Yeah. Thank you so much, Jaz, for your time and yeah, good luck to everyone out there. Jaz’s Outro:Well, there we have it guys. Thank you so much for listening all the way to the end. What change are you going to make from listening to this episode? If you’re on Protrusive Guidance, our app, please comment below. I’d love to know what impact this has on you and what you will change about your mentorship situation or your work life balance or how you want to sort of choreograph your career. Oh, I appreciate you listening all the way to the end. I want to thank Team Protrusive for all the hard work they do. And of course, our guest, Kiran, who gave such a great real-world account of her journey. So do follow her on Instagram. This episode wasn’t eligible for CE or CPD. We’ve got hundreds of hours of content on our app, Protrusive Guidance. So check out protrusive.app. And of course, if you’re watching on Protrusive, you’re already in the nicest and geekiest community of dentists in the world. Thank you so much. I’ll catch you same time, same place next week. Bye for now.

Feb 19, 2025 • 50min

So You’ve Decided to Specialise? – IC056

How do we decide whether speciality training is right for us? Is the best time to specialise straight after Dental School? Or should we gain some experience in practice first? Dr Beant Thandi joins us today to share his journey into specialising and shares some key experiences that will surely help guide you along the way. We discuss the different specialities within Dentistry as well as what personality types may suit them. This episode will really help you understand what it takes to specialise and how to get there. https://youtu.be/f8ZM8EkjSQY Watch IC056 on Youtube Key Takeaways:– Beant is starting his specialization in periodontics.– His journey began during COVID, leading to a desire to specialize.– Proactive learning and mentorship played a crucial role in hisdevelopment.– Financial planning is essential when considering specialization.– Choosing a specialty should align with personal interests and strengths.– Periodontics offers a breadth of practice that appeals to Beant.– The importance of community support in dental education cannot be overstated.– Reflection and documentation of cases can enhance learning and confidence.– Understanding the financial implications of specialization is vital.– It’s important to stay grounded and not rush into specialization. Need to Read it? Check out the Full Episode Transcript below! Highlights of this Episode:00:00 Teaser02:38 Intro to Dr Beant Thandi04:03 Dental Journey06:10 What Influenced You?12:56 Too Young to Specialise17:50 Judgement by Jaz21:00 Never too Young26:05 Cost of Specialising28:23 Why not the USA?31:30 Roasting Prostho34:45 Roasting Endo37:42 Roasting Ortho39:49 Roasting Oral Surgery45:00 Shoutout to Lucy45:30 Final Thoughts47:28 End Outro If you liked this episode, check out a classic: Should You Specialise? PDP006 This episode is not eligible for CPD/CE points, but never fear, there are hundreds of hours of CPD waiting for you on the Ultimate Education Plan, including Premium clinical workthroughs and Masterclasses. Click below for full episode transcript: Teaser: But one thing I learned from a nurse when I was doing a DCT job was people all progress at different rates. It should be competency based, not necessarily time based things. People learn at different rates. And this was a max fax nurse who's obviously seen regists for decades, where I'm sure like, the junior regists are better than the senior regists. Just because they soak it up more. [Jaz]The whole pros element, right? Multiple crowns, four rehabs, lots of general dentist do four rehabs, lots of general dentists do all on fours, that kind of stuff. So, nowadays it’s like blurred lines between, okay, what do they actually need a Prosth for? However, prosth, I think they’re very employable. However, lots of people who do an MClinDent Prosth end up being general dentist. We’re just like really good general dentists in practice and still doing checkups and stuff. I have seen that. [Beant]The fees are 37 and a half thousand pounds a year and they’re subjects- [Jaz]For a home student. [Beant]This is for a home student. I’m a home student. [Jaz]What? How much is it for an international student? [Beant]60, 000 pounds. Jaz’s Introduction:I think every dentist in the world at one stage of their career has thought about specializing. And most of us never do, right? About 90% in UK anyway are general dentists or at least non specialists. Only 7% actually enter specialist fields of dentistry like perio, prostho, endo, oral surgery, you name it. How do we decide whether specialty training is for you? There are huge sacrifices one must make both in terms of time and finances. And how can you be sure that you really want to niche and narrow your scope of practice into that one field that you might choose? Is the best time to specialize like straight after dental school? Or is it good to gain a few years experience or many years of experience before you consider specializing? Hello, Protruserati, I’m Jaz Gulati and welcome back to your favorite on the podcast. I’ve got Dr. Beant Thandi today who’s literally been accepted just now into Perio specialist training. We recorded this a few months ago. So it probably just started his specialist training, but he’s young. He’s a new grad and he’s deciding to specialize early on. He decided that Perio is his calling and be nice to tap into his mindset. Why is he thinking of specializing in Perio? Why not any other specialty? Why not do some more years in general dentistry? Why not do lots of courses in Perio and be good at Perio, but not necessarily be a specialist. How’s he going to finance this? Nowadays, things are getting so expensive. And that includes the fees for specialist training. Beant is one of our community members on the app. So it’s a great pleasure to host him. Hope you enjoy this episode. Covers so many themes about specializing. Like we’ve all thought of these questions before. And you know what? I don’t think there’s any right or wrong answers. But I know for a fact, this will help you. If you’re kind of stuck and you’re thinking, is specialist training for me? This is going to help to give you some direction. Catch you in the outro. Main Episode:Dr. Beant Thandi, you’re about to specialize. Super exciting time. It is so great to have you, to catch you at this stage of someone’s career, because we’ve had specialists on before. We’ve had young specialists on before, experienced specialists. We’ve had people thinking about specializing, but you’re literally in that kind of limbo period where You’re literally about to start specializing in Perio. So tell us my friend about your journey so far. And when do you actually start your program? [Beant]Yeah, sure. So, well, thanks for having me on. So we’ve got long story and short story. So to answer the first bit, which people want to know is I’m starting next Monday. I’m going to the Eastman Dental Hospital, do their three year MClinDent course, hopefully come out a specialist, that’s the plan. It will be, yeah. It’ll be a full time course. So I’ve had a bit of a read of the brochure. It’s going to be like five days a week, pretty intense kind of thing. So pretty much like a job going straight into it. So excited, nervous. I think it’s a happy, nervous, excited. I think I don’t know quite what to expect, but I’m like looking forward. [Jaz]And so tell us, give us a flavor of what got you to this point. So tell us about your dental school training, like your very early stage in your career. And so people decide to specialize at various times. Like, for example, when I look at someone like, Reena Wadia, a well known perio specialist, who’s been on the podcast before. A bit like you quite early jumped on and she’s doing great things. Equally, I’ve seen clinicians who’ve been in the game for 11, 15 years, then they want to specialize and they’re also equally doing wonderful things. So tell us about your journey so far. [Beant]Yeah, sure. So my journey all started with cOVID actually. So, when I was an undergrad, it was middle of third year. So we just started seeing patients literally in the January, February started getting going. Treatment plans were done. We’re actually starting to do fillings. It’s getting excited and then bang COVID hits and we’re all sort of shelved. And I remember during that period we all went online with everything and it was all good. We’re still learning. They got us back. So I trained at Birmingham. They got us back into clinics quite quickly, actually like credit to them. And what happened was it got to a phase where we would go to clinics, go to university, then we’d come home and that was it. Couldn’t do anything else. Couldn’t see anyone. There’s only so many video games and Netflix series you can really watch. So just got quite bored. It’s a bit odd, but it sounds really weird saying this, but for me, I felt dissatisfied and I couldn’t explain it. I didn’t know what it was because I was telling myself and I know it’s still the truth. I’m going to be a dentist and that’s absolutely amazing. That’s fantastic. I’m really lucky to be on the course, like what’s going on kind of thing. And then I was quite literally sat in bed at night going to sleep. And I was like, I never thought about specializing, literally a thought in my head. And I go, hmm. It was literally like a moment like that, like went to sleep anyways, carried on. [Jaz]What year were you in? Was this like fourth year, fifth year? [Beant]So this is the tail end of third year. So start of fourth year, start of BDS four. And at this point we then, so with this in my mind, it’s like, okay, I’m going to just keep my eye out for things. I wasn’t too like diehard about anything. I was like, okay, well I’m in a dental hospital. I’m being taught by a load of specialists. Who else better to kind of get that insight from? And so, we were going through a block during, at the time, where we do specialty modules. So we had pros, specialties, perio, endo, oral surgery, oral med, Paeds, Ortho, all sort of the usual blocks. And I kind of just paid a, I know it sounds silly, a bit more attention to them as could I see myself doing this? Yes? No? And obviously I won’t put down any other specialties, but there were some which I was like, yeah, no, that’s not for me. I respect what they do, but I couldn’t see myself doing that. [Jaz]And here’s an interesting question. I have this big belief from childhood that your teachers, the character they are in your role models that you have, teachers growing up will inspire you to go down a certain route. So for example, if you have a really good history teacher and you’re like in eighth grade, you may well end up doing history at uni. Because of that eighth grade teacher was just amazing. And so I’ve had similar moments that I wanted to, I had a great Endo teacher and so for a long time, I changed my mind from ortho entering dental school thinking I want to ortho to then endo, and then later on restorative and then now being happy as a GDP. So do you think there was an element of that? Like did you have a great per tutors compared to perhaps Endo? Didn’t enthuse you as much as your perio ones? [Beant]Yes, so this is exactly sort of where it was leading to, actually. So I watched the endo, I watched some prosth, and I watched some perio. I quite liked all of it, but I think it’s as you said. So it was good for me to see the staff at the uni doing their own thing and not just on clinic, like in their zone. And it also made me realize how good it is to have a nurse. I was like, wow, this is amazing. You give you assistance. And what caught me was the Perio department at exactly as you said, I think it was the fact that when someone is so keen on something, they just love the specialty, it becomes infectious. And that infectiousness rubbed off on me and I was like, oh, actually, I quite like this perio of business. It seems pretty good because to Birmingham, they’ve got a very intensive undergraduate perio curriculum, so you learn a lot more than just the guidelines and like the things you need for general practice. They go way beyond that just because that’s what the uni’s like. They really enjoy it. We go, like microbiology, immunology, all the surgery, we don’t do it, but like you see the scope of it. So I was like, okay, this is a bit of me, I think, and I had a chat with one of the professors who’s a restorative consultant and I was involved with them through the student society. They were like the staff rep and stuff. So I thought, oh, that’s like, that’s a friendly face. And I just said to them, because I knew I wanted to do perio at the time, and they’re mainly perio, and I just asked them, so what’s special? I’m thinking of maybe doing a specialty, don’t really know what, but basically what are your thoughts? I want to kind of and sort of unbiasedly, obviously they love Perio, they’re going to say Perio, but what do they think? And because he sort of knew me, he said- [Jaz]I think it’s good that you picked a restorative consultant who when they’re grandfathered in from that generation, assuming they’re old enough, then they kind of are on the specialist register for all of them. [Beant]Yep. So they were, they were a specialist register. Well, they are, I should say, on the specialist register for all three. And that’s why I thought, okay, that’s good. They’ve got like a nice view of a bit of everything. They will have to work with all the other specialties. It’s a really good umbrella one to see everything. And they said, endo is a good one for you. I think you do well at that. They were like, what else did they say? They like oral surgery. And then of course they said perio. And then that’s where I’m like, okay, that’s cool. I was like, yeah, I think I’d like to do perio. From then it just kind of went. But in a nice way the consultants and all the departments started really helping me and it wasn’t like a oh, yeah you’re going to be special bam, bam, bam. It was just oh, do you want to come along? I’m going to do this cool surgery come have a look and for me because I was actually enjoying it just on my days off because I don’t know how other dental schools were. But often you’d have like a half day or a day off here whenever it aligned I’d go watch some surgery or something and I was like, okay. Yeah, like this is pretty cool. I could see myself doing this. [Jaz]Sorry to interject, but this is a really important point that I don’t want people to miss is this is a recurring theme in a podcast where we’ve had someone who’s excelled into implants. They were as a student going in and say, let me see this being done. Let me go on the Hypodontia Clinic, right where we’ve had people excel or have this, I guess, affinity towards orthodontics in their time. They were in the cleft clinic and they went on the Hypodontia Clinic or they were in the ortho clinics, basically, and so you have this element of being a proactive learner. And then, the easy thing to do when you’re a student is just play FIFA and that’s it. And just not do that extra stuff. It’s a small percentage of people that do that extra stuff. Credit to you to do that. And then also it kind of like is like work experience all over again. You’re still gauging whether this is still right for you. [Beant]Yeah, exactly that. And, I mean, don’t get me wrong, disclaimer, I played a boatload of Call of Duty during my time at uni. But it actually made me realise, and if there’s students there, you do have a lot of time, downtime, don’t get me wrong, when exams come, that’s a different thing. But when you have those half days or day offs and you just go home, I would just sit in a clinic, and because it’s not timetabled, and the lecturers were quite, please, someone’s watching them do their thing. If I said, quite honestly, oh, I’ve got to go, I’m meeting a friend, they’d be like, yeah, no worries. Like, thanks for coming to watch. It’s not like timetabled clinics where you have to stay. Those horrible clinicians who make you stay, like, right to the end. Well, not horrible, but they make you stay right to the end until everyone’s finished. [Jaz]There’s flexibility. [Beant]Yes, exactly. [Jaz]And what this creates is this environment of whereby the educators, once they get a whiff that, you know what, this person has this spark in their eye, they’re interested, they’ll give you more because they’re seeing that you’re a sponge. They’re seeing that you’re willing to absorb and you’re willing to have these conversations. As an educator myself, when I see a student like that, if you’d like, when I see someone who’s got that hunger, I love it. And I want to put on a buffet for them. [Beant]Yes, and that was literally what happened. So it was this, from this professor, I started watching more period at uni, so I was watching sort of some of the consultants, some of the staff grades. We even had some people who were registrars at the time doing, and I presume we’re going to maybe a bit later or whatnot, but they were doing MClinDent part time, which we can talk about, and they were working at Birmingham, so they gave me another view. And all of this coming together is like, okay, I’m seeing sort of the more hardcore, super researchy side. I’m seeing the people who are doing. more sort of specialist stuff. And then from there, I started watching like BSP lectures. And again, I think the nice thing was there was no pressure to any of this. There’s no exam at the end of it. There’s no one testing me. It was all just my own curiosity carrying me through. And one of the things which happened was that I don’t know if you were there was at the time, it’s called the Manchester Undergraduate Research Society, or something like that. The Manchester undergrads, they do a conference every year, and it’s designed for undergrads, and there’s a range of speakers. One of the classes was a perio class, and it was how to use hand instruments and stuff. And I just went up to the guy who gave a talk, and I was just like, oh, hey, nice to meet you. This is who I am. And from there, he was like, hey man, like, it’s cool you’re into perio. Why don’t you come watch me in practice? And I went down and that was another thing. So I got to see perio in practice because hospital dentistry in real life practice sometimes can be very different and it all sort of painted this picture together. I was like, okay, this is pretty cool. I quite like this. At the same time, I’m obviously doing my BDS training to become a dentist, so I was very aware, very, very aware at the same time, not to let anything else slip, because I didn’t want to, like, you could say, almost fly before you can even take your baby steps as a dentist. I wanted to make sure I understood how to do those root canals, how to do my removable prosth the things, I think. It’s fair to say most graduates struggle with- [Jaz]And stay grounded as you did. And I think if you go back to like, some people might be thinking, oh, this guy is too young to specialize. And you hear that sometimes, right? You might have been having those thoughts in your mind, right? Maybe someone said it to you. I don’t know. Has anyone said that to you? [Beant]Yeah. So that’s another thing. I’ve had a lot of people give all sorts of advice, like good. Not so good, but all well intentioned. And I’ve had periodontists say it to me. And I do agree to an extent. They say you should get your feet grounded in general dentistry, figure out what you like, don’t like, because it’s a massive commitment to limit your entire practice. And I just kept this all in mind. And what I thought was as a, well, I listened to this podcast myself. I have as a student. And I remember in all your advice, you would say things like, and still do, get a camera, record your things, be the best you can, all that kind of stuff. So when I went into FD, I bought a camera when I could afford it. So I think it was in April time. So I’d saved up. So I’ve been working quite a few months and I bought it with the mindset of, I’m not going, because I know some people, and it depends on your situation, they’ll buy sort of not a halfway setup, but a nice setup that will do the job, but yeah, it’s not the bee’s knees, if that makes sense. For me, I was like, nope, I just want to, it’s my personality, I just want to do it once, get it really nicely, and that’ll just last. So I got my setup exactly as you said, I would have my, I’d get in in the morning, I’d put my camera on the side, ready to go, and then my nurse, she’s great, she would always be ready. When I wanted to take photos, she’d be there with the mirrors and I just practiced, I documented all my cases and I found that and that’s a tip I think for all FDs having just pretty much come out of FD. The photos I took, even though they’re not the best, I’m not really going to post them anywhere there for myself. [Jaz]I think you posted a few in the chat group, I remember. [Beant]I sent some privately, yes, so sort of like with the group chats, but when I say publicly, I think, I mean, I wouldn’t post someone like Instagram or something like that at the moment. More for, like, self growth, really, is the focus of them. Just asking for, like, opinions and stuff. [Jaz]Reflection. Getting reflection, seeing what you did well, analyzing afterwards. [Beant]Yeah, exactly that. And, I just found myself getting absolutely engrossed in my dentistry, really analyzing things. And I was enjoying it. And I realized how much, even with loops, you don’t see compared to the photos sometimes. And it was really good to help me really improve. And I really took pride in that. And I also use that during my FD to make sure I felt like I’m at a good enough standard of general dentistry for where I feel I need to be. Obviously that’s hard to dictate when you have a certain FD, but I just wanted to be very solid at everything. If something turns up, I can treat it. I don’t need too much help or, well, to be honest, any help at all, unless it’s something you wouldn’t expect a GDP to do kind of thing. And I actually became quite like the endo man in my FD year because I was in a FD practice where they had special interest endo. And I said to myself, right, this year I still want to do perio, but I’m going to keep my eyes open because I’m still really fresh. I may fall in love with oral medicine, as in you don’t, I don’t know, kind of thing. And so my mantra in FD was right. Anything I don’t enjoy, I’m going to do more of. I don’t enjoy it because I’m probably not good at it. And for me that was endo. I could do endo, but I wasn’t that great at them. I’d be there for quite a long time, kind of, I’d say a lot of faffing out. I feel that’s the best way to put it. I didn’t kind of move when one thing fell to the next, to the next. And anyways, my trainer, he’s like special interest endo and I remember I’d have, I’d take the PA and I’d like, make my diagnosis or whatever. And I’d show it to my trainer and be like, do you think this is endo-able? And it would literally be like a block with no canals. And I’d be like, please, please, no, please. And he’s like, yeah, you can endo that man. Of course it can. And I’ll be like, oh no, why? But actually in all fairness, it got me really confident at molar endos by the end of the year. I wouldn’t say flying through them, but I was a lot more confident with the could do them sort of start to end with no complications. Don’t get me wrong. I’m sure if I did more endos, I’d run into complications. It’s a massive field, but I think for sort of that GDP level of confidence, I would be very happy to extirpate, find the canals. And know what’s too difficult to refer on, kind of thing. I think I was very fortunate. And so, I really kept everything open in FD. I did a lot of pros as well, really looked like doing crown preps, and a bit old school, but three quarter crown preps as well. [Jaz]Good, very good. [Beant]So, I really tried to make the most of all this dentistry. [Jaz]It’s not like you were hedging your bets. You didn’t put all your eggs in one basket and then just did extra for the perio patients and then didn’t just try to avoid end endos and the crowns and stuff. You really made sure you had a well-rounded first year out of dental school experience and to get the exposure, which is really important. [Beant]Yeah, it’s exactly that because I thought alongside all of this, I was like, no matter what I do, none of this is ever going to harm what I’m doing. It’s all growth, it’s all learning, it’s all improvement. It’s all good stuff. And my actual goal was if I got good enough, I’d make it into portfolio which obviously I sent to you to be like, Hey Jaz, how does this look? And I wanted to show this to- [Jaz]What did I say at the time? I remember like opening something up, but I don’t remember the feedback I gave you. What did I say to you? [Beant]So I remember I asked this about a year, no, not a year ago now is it December I checked and I just said, Hi Jaz, sort of, this is my portfolio. It’s from FD. I just want to show a good standard of work that would be expected sort of at my level. What do you make of it? And you replied pretty quickly. I’m really appreciative, actually. And you’re like, hey man, like it looks really good. Like it covers all the things I think someone at your stage should do. And like, it was very positive. So with that sort of in hand. [Jaz]Now, before I get inundated with 2000 portfolio checking service. My fee is 19, 995. No, what I do basically. So just so no one gets upset, right? I either reply in two minutes or two months. Okay. But if you want to get a reply on average within two hours to two days, then it’s going to be on if you DM me on the Protrusive app, on Protrusive Guidance, that’s like, if I don’t get back to you in two hours, I’ll get back to you in two days. If you message me on Instagram, it’s got to be two minutes or two months. Okay. So best place to get me is on Protrusive Guidance. And what I would suggest is if anyone would like to share their portfolio, please come on the Protrusive Community. Just put it there, get over your fear. It’s a nice and geeky dentist who will definitely help you. So put it there and you’ll get lots of opinions and advice. And you never know, you might actually just find your next associate position just by sharing your portfolio on there. [Beant]Yeah, I completely agree because the chat at the time when I was, and I think it was the telegram before, it’s a really nice environment. And that’s why I felt confident to message you, because I think it’s quite a big thing to show people your work. It’s like you’re not exposing yourself, but you’re like, oh, this is how I actually do dentistry. And someone’s like, technically, because you’ve recorded it that way, microscope looking at it, aren’t they? But I felt comfortable enough to do that. And you were very positive with it. And I was like, okay. This is good. So that made me feel a lot better. Okay. I’ve got a nice ish portfolio. Good for where I should be. And then, I know you’ve got some other questions. So we’ll probably dart around, but the aim of the portfolio was I got interviews because I’m aware I’m so young. The question often always asked is you’re a baby. You can’t do dentistry, mate, no offense. But as in, it takes time. And I completely agree. It takes time to learn. But one thing I learned from a nurse when I was doing a DCT job was people all progress at different rates. It should be competency based, not necessarily time-based things. People learn at different rates. And this was a Max Fax nurse who’s obviously seen regs for decades, where I’m sure like some junior regs are better than the senior regs just because they soak it up more. And I thought actually, yeah, like that’s true. People do progress at different rates. So with this portfolio, when I went to my interviews, which I’m sure we’ll get into, I showed them the portfolio and I said, hey, this is my general dentistry. I think it’s important to kind of show you. I can do a fill in, I can do a crown, I can do an endo, like, I’m not going to be complete tunnel vision and only know how to do RSD and perio surgery, you know? [Jaz]That’s such a great way to do it, because when that inevitable question comes up, aren’t you too, I’m going to try and test you in this video, aren’t you too young? And then they’re like, how do you like these apples, right? Look at this standard of work I’m producing. I may be young, but I’ve been doing very concentrated, very high impact training, if you like, with a photograph, right? You’re really going all at it, building your portfolio, which not enough people do. And I always encourage it, but to have the confidence to do it and to share it with someone is huge. Now, one thing I want to talk about is this element of time before starting specialization. Before the next segment I want to move to is we get to roast all the different specialties, which kind of like, let’s chat some crap about all the different specialties. So it’d be a nice little fun segment basically, in terms of everyone listening to this and watching this thing. Hmm. Endo versus ortho and stuff. Let’s give our honest views and opinions. But before we get to that fun bit. I think there is no like thing whereby you’re too young or too old. I think it’s individual for every dentist and you can make it work. And I think the benefit of doing it young is you haven’t picked up bad habits. Common one here. The other benefit is that you haven’t, like, I’m assuming beyond like, correct me if I’m assuming you haven’t got like, you’re not married with three kids and that kind of stuff. You haven’t got a mortgage, that kind of stuff. Right? [Beant]None of those responsibilities. [Jaz]Exactly. And so like, when I look back, I am like for my first five years, every single course that was available to me in like a 800 mile radius, I went on it. And like, when I look back now, I was like, oh man, now with the two kids, it’s very, very purposeful before it was like depth. And now it’s more about quality and stuff, but it made me well rounded. It made me who I am today. And so in a similar vein, before you get a mortgage, before you joined the rat race, it’s just like an extension of your uni training and you’re doing something that you love. And so it’s easy to just continue going. Whereas if you’re a bit older, it might be difficult to get back to exams. And the thing you mentioned about hospital training is when you experience the pace of practice, man, I tell you, that was a big reason I didn’t go back to hospital to specialize because having that pace go back slow again is very difficult to do, but you haven’t tasted too much of that. So you can’t say that. So anything you want to add on being in the stage of career you’re at before you specialize. [Beant]Yeah, so one thing which was really helpful was I was speaking to one of the, she’s more junior reg at Birmingham, and this person, she’s done all four, she’s done loads of stuff, basically. She’s done DCT posts, then she became a registrar, then she went off to do some masters, then she’s done a PhD, and now she’s becoming a restorative consultant. And I was talking to her about sort of, as you said, I feel like when I’m going to practice, I’m going to love it. Like, it’s such a nice way to be. You have your nurse, you control your times, you do this, you do that. Whereas dental hospitals, when you look back, they’re actually very slow as an undergraduate because you have to wait for your clinicians, you have to wait for this, wait for that. [Jaz]Painfully. [Beant]Yes. And she said to me, one piece of advice she had for me is if you don’t get too attached to it, you’ll be okay. And what she meant by that was, and she was speaking about salary. I won’t give numbers, but you’ll have an idea of what sort of a hospital sort of bread is on compared to an associate compared to, I don’t know, a super all out, all on poor dentists. People have an idea and it’s not too much about money. She said the thing which can get quite difficult is you do your foundation, you might do a DCT year, then you go into practice and you’re on a nice healthy salary. Some people more, some less, but it’s a really good salary, right? I said the thing that can be very difficult is when you go back into these training posts, your money goes down again. And it can be quite difficult to readjust to that and the line which got me was she said to me, I’ve never done that. She said, I’ve always sort of taken it very slowly. So as I’ve gone from sort of DFT to DCT to like lecture to register, it’s incrementally increased. She’s like, I’m not at the same level as all my colleagues in practice are, but to me. I’ve always seen an increase in my salary. She said, so for me, that’s great. That’s good. But she said it’d be difficult, obviously, if I went from practice earning all that money to then going back down, because then I might have worries of how do I pay my bills? How do I, my car, that kind of thing. Whereas it’s all, I guess, living in your means whilst your salary is slowly jumping. So I kept that in mind whilst I was sort of doing my early years. Like, okay, I’m enjoying this, but I don’t want to get too comfortable. Yeah, and I took this a bit wider of, I don’t want to get too relaxed in practice because I know once I stop and I’m happy in practice, I won’t want to do a lot more intense, intense study. So I kind of kept that mindset up of in during my foundation year and my dental core training year. I want to go back into training. Don’t get too, too relaxed. Just keep it in the back of your mind. You’re going to have to keep watching lectures and stuff again. And that’s helped me a lot, actually, I think. Well, I hope I’m not going to be shelf shocked when I start my training. [Jaz]I think that’s a great point you made, refinances, and how difficult it is to readjust to actually now, instead of going from a salary to no salary, and now you’re actually paying the establishment to actually train you. But when people are 10, 15, 20 years, for those who choose to have children, they’re already thinking about private school and bigger houses and cars and financing the practice. And so it was very difficult to then, because when you go back into training at that stage, you have obviously the expenditure of the fees, and we’ll get to that in a moment for the course, but then you have opportunity costs as well. Now that you’re actually giving your time towards uni, you’re not actually making an income. So you’re actually not only dipping into your savings potentially, but then you’re also losing out the income that you would have gained. [Beant]Yes, very stressful times. [Jaz]And investment. So in a way now that you don’t know any better, if you know what I mean. You don’t even know any different in a way co you can still continue that trajectory. So on that topic of finances, before we get to roast the specialists, how much does it cost to do so? Remember guys, we’re in the UK, in the US and then that, another question I wanna ask you is, did you consider the US, we’ll get to that, but let’s talk about the UK, your program. How much is it costing you per year? And just give us a flavor of that. [Beant]Sure. So this is the bit where I, and I’m sure everyone else will cry. So I’m very lucky. I’m really pleased to say I’m going to the Eastman. Can’t quite believe it. And it’s a three time, three year full time master’s in clinical dentistry. Drum roll, please. Not really going to cry. The fees are 37 and a half thousand pounds a year and they’re subject to- [Jaz]It’s for a home student? [Beant]This is for a home student. I’m a home student. [Jaz]What? How much is it for an international student? [Beant]60, 000. [Jaz]Damn, inflation. Do you know how much it was back in I hope I’ve got my, like, facts right, right? I think back in the day when I was looking at these programs, it was about, it was either 18 or 23k at that point. Yes, so Let me know what you think. [Beant]So, to make myself cry, I remember looking in fourth year. And the same course cost was about 23 grand. So in the space of what, three, four years, it’s gone up by 12, 000 pounds, which is absolutely astronomical. And then as well as that, I’m not from, I’m from the Midlands, so I don’t live in London. So I’m going to also have to bash out living in London as well. So it’s a lot of money. And I’ll be very honest. My family, cause I’m sure this is what people want to know. I’m very fortunate. My family can help me pay the tuition fees. There’s no beating about the bush. I’m very lucky. I’m very privileged I wouldn’t be able to even try for this if I didn’t have the support of my family. And I think it’s important to be honest about that and not make people think oh my gosh, what am I doing myself? How’s this guy done this? I’d like to be very honest and the other thing I’ve done as well is during my All my employee time, FD, DCT, that salary’s all been saved. I’ve lived at home, saved all of that. And that’s, I’m going to sort of pay for all my living costs in London as well. Because as I’m sure a lot of people know, London is not a cheap place to live. And I’m hoping to start work later on down the line in the course. So that’s sort of the headlines. It’s extremely expensive. And that’s, I think, another reason why people tend to do it when they’re a bit older. They’ve worked in practice a few years. They’ve got the money behind them and it makes perfect sense, really, because it’s a real big barrier and it’s quite a shame, I think, actually, but that’s the headline. [Jaz]Did you consider, and I appreciate it, honestly, and it’s great to have this, sort of, everyone’s unique story, so that’s good to know, did you consider U. S.? Going to the U. S. to do a Perio Prosth program? [Beant]I did for about 30 seconds, so I did, look, all the periodontists I spoke to, who spoke to me, they said you get just because of the nature of the way the Americans practice, nothing wrong with that, nothing better or worse, just the different way they practice. They tend to do a lot more surgery in America. If you want to be a periodontist, you are a surgeon. You want to do surgery, get the practice. I spoke to one of my professors at university. And he did the maths penny for penny. He’s quite a big name. So he’s got connections all around the world. And he worked out to be about a million pounds, great British pounds cash. It is going to cost you over the course of the duration of the fees. So, I mean- [Jaz]Those who are listening to Spotify, you did not see the way my mouth just opened there. So this, so the way this is calculated is basically the tuition fee plus the living fees there. So does that also take into account the lack of income that you get, or? [Beant]Yeah, I don’t think it was lack of income, I’ll be honest, because once he hit me with that figure, I was the same as you, my mouth just dropped open, and I knew that’s way too much. You can’t afford that, like that’s crazy money, and I didn’t really entertain it too much, but I asked him a bit, and he said, well, in university, or sorry, colleges in America, and don’t get wrong, you may get a lot of people say this is different, and it’s not the case, I just took my professor at face value, but he said. At colleges, you may be looking at like 50 grand a year for a whole three years. And then you have to pay for your books, your textbooks, everything. It’s not sort of all included in the price. And I’ll be honest, when I just heard a million, I was just like, what? No. And I think another thing for me, which was quite important was if I was to go to America, and this is a lot of advice people gave to me, if you’re going to America, the costs are out what is set in America. In order to make that back, you’re going to want to practice in America to be able to repay off your debts, aren’t you? Whereas for me, my friends, my family, my whole life’s here. I’d want to come back to the UK. And I thought for myself, there was no, I didn’t see any real benefit in going to America, getting over set, because in debt, along with my student debt from undergrad, just to be a sad, in debt little man for my whole life. So that was quickly written off. [Jaz]And I think it’s good you did your research and it’s important to share that. Now, whether those figures are higher, lower, it doesn’t matter. It’s important. Everyone does their own research. It is true that specialist training will be a lot more in the States than it is in the UK at this moment in time. And the earning potential in the U S we know is greater and in the UK. And I think you hit that true, but you also are correct that the surgical experience you get in a perio program in the U S is significantly more in the UK. That’s something we’ll come in terms of it. How do I know that when I was doing my DCT in Sheffield, like they were talking about some of these, Indian international students coming over and also from the Middle East and they started this program in the UK and they were like, well, hang on a minute, like I’ve only done like two surgeries and it’s been like three years or whatever, right. Or whatever. I’m just making that up. And then they’re like, my friend in Texas has done this many surgeries. And so there is that element there. And so you’ve got to consider it. So now is the point we get to roast especially. So, Beant, why did you not choose prosthodontics? [Beant]So prosthodontics I actually have a big love for Prosth and this isn’t me just like cushioning it before I say no one. My final year tutor was a really big on prosth. He absolutely loved it. He always he did a mfc back in, was it the 90s or early 2000s at Manchester? He learned all sorts of things. So sort of like your victoria rims your admix. That’s where I did the three quarter crown perhaps like I really enjoyed prosth but and this is where I apologize for all the prosthodontists out there. I, because I’m doing the MClinDent route, I have to be very honest and look at finances. It’s all well and good applying for this degree and thinking I’m doing great. If I stay in debt forever, well, for me, that’s not really a fantastic life to live. And I thought about it as a general dental practitioner, and I spoke to my colleagues. I was like, when would you refer to a prosthodontist? And it was hard to kind of answer that because from our perspective, you wouldn’t really, me and my friends, and obviously it’s a limited group, wouldn’t really refer necessarily for a crown. I love doing a crown, I’d want to do it myself, you know? And then removable pros, again, I think it’s just because of where I was taught, I love doing it, I love getting a nice suctions here on my upper denture, or when I’ve pull those impressions out. I’m like, yeah, this is going to be a good one. There’s not a lot of things I thought I’d refer for. And the only things I could think of would like really complex restorative rehabilitation cases. And in which instance I probably refer to a dental hospital anyways, because if I offered a patient all the options, which I would, it’d be. You can go to your NHS or you can go and pay 20 grand for a specialist and well, I know what I would do. I tried the NHS first. I think we’re very lucky to have that system in this country. And so it became sort of a bit, well apparent to me. I think the referral base for doing prosdontics privately, maybe a bit more difficult to sell because ultimately I will be end up in practice and it’s fantastic having all this extra knowledge, but if I can’t rerate myself for the amount of investment I’m putting in, I think that’s going to be a bit sticky hole for myself. So that’s why I didn’t choose pros it was, I think a difficult one and also I prefer perio more like the surgery, the gums, the guts, and the finesse of it. So yeah, that’s why I didn’t choose pros. It was I think like sort of a longer term outlook. It looked great sort of the offset. But for me, I just didn’t feel it could match up, you know at the end. [Jaz]I totally agree. But, massive respect to my prosthodontist friends, but sometimes it’s difficult to establish yourself as that referral base. And sometimes I think maybe you’re just getting all the shit. One of the jokes I make, and some of my best friends, Hodge and Ricky, they’re prosthodontists. One of the jokes I make on courses is refer this patient who you don’t like to a prosthodontist you don’t like. So it’s like a little joke I make. So sometimes you might see in this hospital, sometimes you get all the junk. basically, right? You get the junk. And sometimes it’s not the procedure is difficult. It’s the patient that’s difficult. And she always wants someone to refer to, but that’s not a reason not to do prosth, but the whole prosth element, right? Multiple crowns, full mouth rehabs, lots of general dentistry, full mouth rehabs, lots of general dentistry, all on fours, that kind of stuff. So nowadays, it’s like blurred lines between, okay, what do we actually need a pros for? However, pros, I don’t think there’ll be, I think they’re very employable. However, lots of people who do an MClinDent and Prosth end up being general dentists with just like really good general dentists in practice and still doing checkups and stuff. I have seen that. So good point there. Why not endo? [Beant]Endo? I’ll hit you with the main one. I don’t think I could be hand filing toothpaste for the rest of my life. So I really enjoy endo actually. I think when I graduated at Birmingham, we got some good numbers actually. I have to give them credit. I did like a molar, incisor, I did a canine, I even did a re root canal of a retained root, that was a whole car crash, but I did it and it was a good experience. But I came to like Endo a lot actually during my FD to do all this stuff, but I think it wasn’t what’s wrong with Endo. I think it’s what I preferred with perio. Perio, sort of, you’ve got the non surgical, you’ve got the surgical. If you want to go into a bit of oral medicine, you can as well. You’ve also, if you want to be a bit of a nerd, you’ve got the immunology, you’ve also got the microbiology. It’s really broad and I didn’t quite see that sort of breadth within a specialty. I know it’s called a specialty obviously for a reason, but for endo, obviously, it’s RCTs, your main bread and butter all day, isn’t it? Whereas I feel like, for me, Perio offered a bit more. If I want to just do non surgical debridement all day, I can. But if, hey, if I want to be doing gum surgery all day, muco gingival stuff, or implants, it’s still within my remit. So there’s a lot more out there. But I do think I would have got a bit stir crazy in practice, just only doing, like, lower and upper sixes for the rest of my life. [Jaz]I remember being on a train once, train journey. I was a dental student. I met a dentist on there who, you notice I was a student because I was reading understanding partial dentures. One day I’ll get there and he saw me, he said, he struck a conversation with me. He says, oh, I’m a dentist, kind of thing. Oh, nice. And he asked me about what my goals are. I was like, you know what? At that time I had the Dr. Godfrey at dental school and he reinspired me and I was like, you know what? A quite fancy endo. And then he said to me, ah, the problem with endo is you’re specializing in something that’s about. This tall is about this tiny, basically, right? And it made me think, but that’s not the reason I didn’t go for endo in the end. I actually think endo’s a phenomenal specialty for the following reasons. Like if you want a job as a dentist, that you don’t bring a dentistry home with you, right? Endo is a good one, right? Because when you’re a prosthodontist, like, like Ricky and Hodge, they’re constantly planning, they’re looking at cbct, they’re doing letters to their patients kind of thing. It’s nonstop. Okay. What I do, where, whether I’m doing some Invisalign or I’m doing some a tooth wear case. I always have my clinical at home with me as well. You know, ask my wife. In perio, I think you will do as well. You’re doing implant planning, you’re thinking, you’re planning and stuff. Whereas with endo, yes, I’m sure. I don’t want to discredit the amount of planning that goes into it, but it’s very much, you got your scope on, you’re in the game and then you can just go to the pub and not have to worry about anything, there’s a huge element of that. And it’s not something noble about saving teeth, right? There is something noble and beautiful about saving teeth. So if you want a high income speciality that is good work life balance, maybe it is something like a noble cause of saving teeth, getting people out of pain, et cetera. I think endo, I think endo is a fantastic speciality personally. [Beant]I think I’d agree as well. I think it comes out, as you said, personalities, if you’re that kind of person who wants to go home. And I respect that a lot. [Jaz]If you’d like protocols, if you’re like very protocolized and you’re very disciplined in that sense, and you’re happy to just do one element, like a really high level, great. But like I said, if you want a breadth, then perio offers that. Why not go into, which other specialties are there? I don’t want to go into like oral med and that kind of stuff. I think the main ones I want you to talk about were Prosto and Endo as competitors. Ortho, let’s just do Ortho. Let’s just roast Ortho. Okay. Why not Ortho? [Beant]So, well, I think ortho is a funny one, so that, well, not funny actually. I think a lot of people get exposed to that when they do their work experience or they have braces and they’re like, yeah, this is cool, and I was the exact same. I was like, dude, this is quite cool. This is before I’d even done dent, like got into dentistry. I was like, actually, like, you can see the way they change their smile. You see the patients regularly. It seems quite nice to see from the patient perspective, quite relaxed and quite cool and chill. It’s like, yeah, yeah, this is cool. And then, I’ll be honest, I think it’s that personalities to specialties thing. When I have my ortho training, and in fourth year, I was like, oh, this is not for me. I mean, I can appreciate it, especially like the orthognathic level stuff. It’s extremely impressive. It’s life changing, all of this. I’ve got a very big respect for it. But I was like, no, for me, I couldn’t think of anything worse than just planning and just trying to figure out movements, over jets, overbite. I thought, no, I just want to get in there and like do stuff. And also just less on the oral surgeon, ripping out the people, the max fax surgeon, the orthognathic surgery. I was like, ah, I think I couldn’t see myself doing it, literally sort of like visualizing my head. Could I see myself doing ortho? And I was like, no, I just don’t think I’d be happy. It just doesn’t suit my personality, to be honest. I was like, yeah, nah, I couldn’t do ortho. For me, it was just boring. [Jaz]I used to think that orthodontists don’t have a pulse, but then I met some really charismatic, cool orthodontists and then that changed my perspective. But there’s a famous saying, if you don’t like dentistry, become an orthodontist. Like if you don’t like the matrix bands, the blood, that kind of stuff, you want something that’s very clean, then ortho, because ortho is more the planning, it’s in your head, the actual treatment plan, it’s the thinker’s game, right? Exactly. So maybe it does attract certain personality types more, income wise and that kind of stuff. You can’t touch it. It’s golden. Like orthodontists do very well overall. It is something that you do take home with you in a way, and it can have a downside. If you’re seeing lots of children, it’s very high paced, but overall it’s a great speciality. Lots of thinking, think about growth and that kind of stuff, and even treating adults and the demand for straight white teeth will always be there. So orthodontist will always be employable. Just one more, my friend, oral surgery, let’s roast oral surgery, because yes, you mentioned the F word, right? You mentioned finesse, right? And I think that’s why I think of a periodontist holding a scalpel compared to a oral surgeon holding a scalpel. That was one thing that a periodontist once told me. Is that the reason why you didn’t go oral surgery? [Beant]To be honest, I think it’s cause I got exposed to the perio more before the oral surgery. And I saw the way they had all that delicacy and finesse. So yeah, I love the finesse compared to oral surgery. And I quite like doing cosmetic aesthetic y things, but I wouldn’t do aesthetic bonding. For me, it’s a bit too high pressure, high states. It’s not a match for me, but I thought, Oh, like doing like gingivectomies or recession coverage grafts, like that’s a bit of me that. And then, I quite like the principles of surgery and for oral surgery, it may be a very naive view, but it feels like when you’re in practice, you’re primarily just going, not just, but you are going to be taking out teeth. And I did a really good DCT year, just gone in Maxfax. I did a New Cross, shout out New Cross, fantastic unit. And one of the things they said to us was it’s a numbers game with oral surgery, not in a bad way. The more you do, the better you get it. And you can whip wisdom teeth out in 10, 20 minutes. 20 minutes is long. Bang, bang, bang, bang, bang. And I kind of thought, well, this is after I’d already decided I wanted to do perio, but it kind of reconfirmed. I, again, I like the breadth that comes with perio and oral surgery is very much, it’s like a military mission, right? We’ve got to take out this tooth, whatever costs, you’re getting it out. Do it. And I was like, yeah, it’s cool. But I think it would get a bit too routine for me. And again, it’s like endo. I think if that’s the way you would kind of. It’s a fantastic specialty. I’ve got a lot of respect because, don’t get me wrong, half the things they take out and I’ve seen taken out and I’m like, I don’t know how you’ve done that. Like in my max fax, there was a, oh gosh, it was like a horizontally impacted, or what was it, three molar. And it was in the palate and it was, the roots were in the line of the arch or something ridiculous. They were crossing between like the palatal side of the five and the buccal side of the four or something crazy. And they’re having to like dig in through the palatal buccal side. And I was just, I was a system. I was like, like, gosh, this is insane. Like, this is really cool. Just couldn’t be taking teeth out all day. I think I still love taking out. [Jaz]I think that in terms of implants and the stakeholders of implants, prosthodontics will claim that, oh, we are the stakeholders of implants. Perio very much have a strong claim for no, it should become, you know, implants should be a perio speciality. I mean, no one will ever stake a claim in that oral surgeons. Plenty of oral surgeons that are really into their implants. So you always have that scope as well. So you’ve really got to figure out, okay, day in, day out. I think a great top tip would be, if you’re considering specializing, go into practice, observe an oral surgeon, observe an oral surgeon. That’s both working in more of an extraction remit, but also one that’s doing implant remit. Do the same for Perio. And then you will get your answer in terms of what’s the kind of daily workflow. In terms of another way to think about it, that these different specialties is gratification. So you have some specialties that lend themselves to instant gratification, like endodontics in a way, right? Obviously you have to wait for it to heal, but you get that thrill of the field or the post op x ray, you get that applause there. So instant gratification, endo or surgery in a way, and then the delayed gratification like perio, ’cause you could wait for their healing orthodontics is very much delayed gratification. And so I think your personality type also may lend itself in terms of how would you like to be gratified? [Beant]Yeah, I think so too. ‘Cause for perio, like in my FD year, I still want to do my very perio, very sort of systematically well for the level I could do. And I would come in and I’d ask my patients all a simple question. I’d say this sounds. And I’d phrase it like this, this sounds really stupid, but has anyone shown you how to brush your teeth? And then to sort of ease it off, I’d say I was only shown properly in my third year at uni, and I’m training to be a dentist. And then they’d all be a bit disarm. And I think is all the tips from your podcast, actually, it was where you invite the patient to allow you to sort of explain things to them. So you get that invite, ask permission first. Yes, exactly. And the amount of patients it changed. And I’ll be like, so you should do it like this. One, two minute thing and they’d come back and they’d be so glad they’d be like my bleeding stopped to feel so much better and this would be like at the checkups later down the lines for people not with like gingivitis, not necessarily like your grade four stage C whoppers. And I really like that because I think the patients can see the long term impacts. As you said, I think it leans to my personality style, which is all the reason Perio kept confirming to me. [Jaz]I think Perio, I mean, I don’t want people to come away thinking that, oh, after this episode, Prosth doesn’t sound so great. I don’t want to bash any speciality, but overall, Perio, I think is a good speciality in the breadth that gives you, because we have an aging population. We’ll forever have recession. We’ll forever have gummy smiles. We need crown lengthening, both aesthetic and functional and patients who don’t respond so well to initial periotherapy, periodontist is a great specialty. So congratulations for making that decision. I’m very excited to see your development. You’ve answered all the questions I had, and I think as a Protruserati, it’s great to see you get in. So well done. It’s so nice. And please do keep us posted on the Protrusive app. Tell us monthly check ins or every six month check ins, how are things going? What are you learning? It’d be really exciting to see your growth. And as you’ve been in London, if I’m in central London, I’ll hit you up. Go to Dishoom together and we’ll catch up. [Beant]No, that’d be great. Thanks. And I just want to say thanks for letting having me on. And if you don’t mind me doing one thing, one of my friends, Lucy, she’s going to be really embarrassed. She’s like, can I have a shout out? And she’s like, I was laughing. It’s like, yeah, I’ll give you one. And she’s like, no, don’t do that. I’m going to be so embarrassed if you do that. So Lucy- [Jaz]Surname, otherwise all the Lucy’s will be like, oh. [Beant]It’s Lucy Whistle. Now she’s going to be really embarrassed and kill me. [Jaz]Dr Whistle, thanks so much. [Beant]Oh, she’ll love it, but hate it at the same time. But it got me thinking of just one last thing I want to say, and it’s just a tip for everyone. Obviously, it sounds fantastic. I’ve got in and I’m really grateful, but me getting in was a complete team effort, definitely not myself. It’s all the people I’ve met along the way. It’s the periodontist, it’s the peeper units, the people through all the posts I’ve done. They’ve all given me tips here, tips there, helped me do this, helped me do that. And I think when people look at specialist training, it’s quite daunting. The way I would look at it is look at dentistry. When we all came to undergrad, think of like I presume like your parents may have helped you, your siblings, your teachers. You might go on like a course. I don’t know. It’s all a team effort at undergrad level. It’s the same thing here surround yourself with good people. They’ll help you out. Everyone will give good advice. And yeah, it’s a team game like I completely say that with open arms I would not have gotten in without the help from everyone along the way. [Jaz]Amazing. No, it’s a lovely little tip. Do not do it alone always people to ask. And if anyone wants to reach out to you, be able to be like, Hey, you know, I’m thinking about Perio. Can I get some advice? How’s the best to reach out? [Beant]Yeah, of course. So, I think I can give you my email address or something. They can just email me. [Jaz]Come on the app and they can DM you. Okay. On the app, basically. And therefore we’re not giving your email out to thousands of people and you’d be inundated. Your full time job will be replying to emails about specialty training from all over the world. So, thank you so much for sharing that. That was really valuable. I think it’s great to, it was nice to just talk about different specialties and give a perspective. These were just our opinions, but it may help someone to decide or not decide to specialize. So, thanks so much, Beant. We’re wishing you all the best. Maybe we’ll get you back, maybe to the middle or to the end of your training to see how things are going, get a flavor of that and wishing you all the best if you ever need anything. I now live in West London. Give me a shout. We’re always here to help you, both me personally, but also as a community, we all have your back. [Beant]No, thank you. And I mean, same for you guys and by everyone listening as well. It’s a great community, Protrusive, very diligent, like anything I can help, more than happy to even if it’s just a, Oh, Hey, what do you think of this? Yeah, cool. So saying back out at yourself and everyone who’s listening, happy to help. Jaz’s Outro:Amazing. Thank you so much, buddy. There we have it, guys. Thank you so much for listening all the way to the end. This one is not eligible for CE, but there’s hundreds of hours of CE waiting for you on Protrusive Guidance. It’s the home of the nicest and geekiest dentists in the world, and I’ve got all my like Master Classes in there and all the CPD questions for 99% of the episodes, which are eligible for CPD. I want to thank Beant once again. He’s been a Protruserati since he was a student. It’s been great to see his progress. I’m so excited for you Beant to enter your specialist training and we’ll keep in touch, see how it’s going. We’re all rooting for you. If you know anyone who’s thinking about specializing and they’re not sure, maybe send them this episode and thanks again for always tuning into Protrusive. I want to thank my team as always. Erika, Gian, Julia, Krissel, Mari, Rakesh, Emma, and Nav. You guys are what help drive Protrusive and help us to create the content and serve you guys. Thank you so much. I’ll catch you same time, same place next week. Bye for now.

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Protrusive Dental Podcast

Episodes

Mentioned books

My Neck, My Back (Fix Your Posture While Removing Plaque!) – PDP220

Minimal Preparation Veneers – PDP219

Decontamination CPD Made Enjoyable! – PDP218

Work Life Balance + Setting Priorities – PS014

Your Endodontics Questions Answered! – PDP217

How to Find a Mentor in 5 Seconds Flat! – IC058

Working Lengths and Troubleshooting Apex Locators – PDP216

Medication Related Osteonecrosis for GDPs – What You Need to Know (MRONJ) – PDP215

Associate’s Journey of Growth – IC057

So You’ve Decided to Specialise? – IC056

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