Protrusive Dental Podcast

When you present your patients with the ideal options, but they end up choosing ‘patch-up’ Dentistry…this is a real world problem, and we will tackle it in a comprehensive way in this Group Function! Thank you Anonymous Dentist on Instagram for sending in this BRILLIANT question: Hey jaz! I’ve been listening to your podcast and I’m a huge fan!I especially enjoyed the Chris Orr one and the communication one.I just wondered if I could have some advice please..I’m working across two practices at the moment, 1 fully private and 1 mixed practice.At the mixed practice, often patients with broken teeth don’t want to pay for crowns/onlays even though I spell out the benefits, often they will go for a replacement amalgam (which I hate doing) or a large private composite (again risk of debond due to the size)What would you recommend? If a patient doesn’t want to pay for a crown /onlay but you’ve spelt it all out then I’m not sure what else I can do?Thanks in advance! X Anonymous Dentist in the UK, Instagram https://youtu.be/Y9xGee14LMg Real world problem in Dentistry…what is the solution? Full episode above You all know what happens when you get Zak Kara to give a quick answer….there is not such thing! Dr Zak Kara goes way beyond the call of duty and delivers us solutions in his signature comprehensive fashion! We tried to steer away from the NHS vs Private Dentistry debate too much – but definitely your environment and the values of your patients plays a huge role. Thank you so much for sending this question in – if anyone has a question they want to submit, do contact me via the website or send your question via DM on Protrusive Dental Instagram. If you found this valuable, share it with your associates and principals. If you liked this, you will also like Zak’s gems on Communication in Episode 10! Here are some comprehensive notes/episode summary was written by fellow Protruserati, Taha Adamji – Thank you, Taha!: PDP GF002 – Communication with Zak Kara – patients always choosing the inferior option ROLE PLAY  Building rapport as you’re coming up/welcoming them in  E.g. How was your journey in today?/How’s your day going today? Feel free to put your things over there and take a seat – give them clear direction when they come in about what to do  What can I do for you? My molar broke – yes I heard, (Receptionist name) told me you’re having a bit of trouble with a tooth on the UL  I’ve had a look through your notes/X-rays/photos etc – from your previous visits – this shows you are well prepared to help them  Sorry to hear that/ that can happen sometimes (empathy) Is this the first time this has happened to you or has it happened before? (History)  Am I right that it doesn’t/does it hurt right now? Is it rough to your tongue/uncomfortable? Patient mentioned the clinic/gave praise Thank you/that’s kind of you to say, I’m reassured by that/what do you already know about us?/it’s your first time seeing me /you saw (x) dentist previously is that right? – all shows you have taken the time time to read their notes/are interested in them and their past experiences Patient apologised for not coming  That’s no problem/Don’t apologise/there’s no need to apologise. What we do here is always blame free/judgement free dentistry Let’s see how we can help you with this problem tooth today: Because this is a “get you of of trouble type of appointment”/urgent/emergency appt, the aim for today is to focus on that one tooth I’m not going to do a full health check/exam today if that’s okay, I’m going to focus on this main problem for you But let’s also check there’s nothing else urgent going on and then we’ll see if we can get this problem solved for you by the end of the visit  What did you hope or expect was going to happen today? (Check expectations) “I was hoping it could be patched up and then I would be on my way” that’s definitely something we could do for you to make it smoother/perhaps take away that sharp edge so that it’s more comfortable  Does that sound okay to you? “How long is that going to last me” Well why don’t we take a bit of a look at it/I’ll put my magnification on/mask up (emphasises you’re going to look at it carefully, in detail)  don’t over promise too early – investigate it first, don’t make any assumptions about treatment options yet  Often when a tooth breaks there’s a reason behind it / did you have an idea on why that might have happened in your tooth’s case? “ I shouldn’t have had that chocolate” Patient/dentist may tend to focus in on the tooth in isolation only – but we need to look at the mouth and the patients as a whole   what is the patients goal here?  any pain to resolve? Roughness/sharp edges – we are going to solve this today  Long term goal/expectations? Examinati

Dental Implant courses for Dentists are a significant pathway in terms of commitment. Have you ever attended a Dental course and not applied the knowledge…and then a few months or years later – you felt it was an absolute waste? For example, I did a laser course last year – I have hardly touched a laser since then – its my own fault and I take ownership of that…but what if the stakes were higher? https://youtu.be/rXYARG13AEQ Is it too soon to start Implants…? Implant courses are not a small investment and I know some Dentists who have invested heavily in implant training…but they never quite got going. Whatever the reason, it’s sad. This is why I recorded with Implant Dentist Dr Hassan Maghaireh who is going to help us over 2 episodes to cover this mammoth topic. In this episode we look at getting started with implants – is it for you? https://youtu.be/dSgGnoTyC1c Should you be placing Implants? Stay tuned for a very clinical Part 2 where we will discuss case selection, implant assessment and Ridge preservation for Dentists. This two-part series aims to help you even if you are not placing or restoring implants, we’re going to cover the fundamentals and scratch in itch we have all had since qualifying from Dental school with limited exposure to Implants! In this Episode, I asked Hassan: As you do not get to place or restore implants at Dental school, how can you know it is the right path for you? I know many young Dentists who dabbled with implants and then stopped placing implants – how can we ensure this does not happen to more dentists? There is a school of thought suggesting that with implants, you should either go all in, or do not touch them. How and where does the GDP fit in to this? Is there a place for ‘dabbling’ in implants? How can we start safely and positively? In this episode we promised you some downloads and resources: The ADI Whitepaper on Bisphosphonates The BAIRD Implant Course starting in October 2021 Wex for Refurbished Photography Equipment If you enjoyed this episode, you will also like Transition to Private Dentistry which changed my life.

This is the very first Group Function and we are tackinling RBBs! I will take questions from the fellow Protruserati – I will use your help to come up with some helpful solutions. TLDR: You can do Dahl RBBs, but it doesn’t always mean you should. A little prep of enamel will not be THAT detrimental for the tooth. https://youtu.be/VtRlzodts8c Thank you Aaron for helping this episode happen as our first question! It is about a technique dear to my heart – Resin Bonded Bridges! Firstly, if you know nothing about the Dahl technique, you totally need to listen to the episodes with Tif Qureshi on Dahl Part 1 and Part 2. It CAN be a good way to place Resin Bonded Bridges in a way to eliminate any preparation for the occlusal surface – in young patients it can be very successful. However, it just seems a shame to prop someone’s bite open on just ONE tooth and allow what naysayers refer to as ‘unpredictable orthodontics’ to work it’s sweet magic. I am totally fine with a little prep – staying in enamel (which is so key!) – every case is unique so treat on it’s merits. In a younger patient, I am more likely to consider that approach. I hope this helps! If you find this useful – send it to a colleague. I cover Dahl RBBs extensively in the Resin Bonded Bridges CPD Online Masterclass as well as Zirconia RBBs.

When Mike Gow first told me that he helped place dental implants on patients WITHOUT local anaesthetic, I thought he was lying. Then I found out they have also done a sinus lift without LA…what?! You read that correctly! Mike Gow has centred his practice around the management of nervous and anxious patients. Don’t you think we can learn so much about management of dental anxiety from someone who has achieved the above? This is exactly why I brought him on as my guest of honour for Episode 50 (50 not out!) and you will love this, gem-packed podcast with valuable ways to help us become better Dentists to anxious patients. https://youtu.be/dkMByGXwI1A Full episode with Dr Mike Gow only on Protrusive and Dentinal Tubules The Protrusive Dental Pearl is to check out Anydesk (it’s free!) to gain remote access to your work computer in a secure way, so you can access X-rays and treatment plans any time, from any where! This has helped me on so many occassions! Also check out the 1 hour free training on Teeth Whitening by Dr Payman Langroudi of Enlighten Smiles. https://youtu.be/jO0bIetHLtY We discuss: How and why he found himself in a situation to hypnotise patients and place implants without LA Mythbusting about Inhalation Sedation Top tips in making patient feels calm and cared for (gold) Gow Gates vs Akinosi – which ID Block alternative is better? How to have a thriving practice centered on anxious patients The powerful secrets of managing dental anxiety https://youtu.be/uqiXh6QUjXw Inhalation Sedation is massively underutilised https://youtu.be/LevjbyjOTIM Hypnosis is powerful! Mike’s resources as promised: ISDAM Website ISDAM Facebook page His practice, the Berkeley Clinic And of course, Mike on the news!: https://www.youtube.com/watch?v=D04uduXkYJ0 Dr Mike Gow also runs InterDental TV for the latest in Dentistry. If you enjoyed this episode, you may also like Dr Libi’s 2 episodes on Paediatric Dentistry!

As our level of Dentistry gets more comprehensive or complex, sometimes it is useful to write a treatment plan letter to your patient. In some practices, this is considered absolutely essential. https://www.youtube.com/watch?v=_sMt7QLaPCk Full episode with great gems from Dr Jorge Cardoso The problem with writing treatment plan letters to your patients is that….it’s not easy! It takes time. It takes thought. You need to come up with solutions to the unique and complex problems for our patients, and be able to present an estimate of fees at the same time. Not only that, but the letter should ideally be easy to understand, visual, detailed enough to be valuable but at the same time concise enough not to complicate it. Oh and by the way…after all that time and effort, the patient may not proceed with treatment. There goes that Saturday afternoon away from family, totally wasted, right? https://youtu.be/bo-fA-o4OC0 I found a solution. Kind of. It’s called MakeMeClear and it generates easy to understand, visual and beautiful treatment plan reports and letters. Once I got slick at using Make Me Clear, I still found it takes time. There is no shortcut/hack to good treatment planning. But there is a shortcut to creating wonderful letters that increase your case acceptance. Thank you, MakeMeClear! Protrusive Dental Pearl – Do the 21 Day Free Trial for MakeMeClear and do not make the same mistakes I did of not taking action! (It will be more clear when you listen to the episode). All of the Protruserati clan get 25% OFF the monthly or Annual plan with the code ‘protrusive‘! If your dental practice subscribes to MakeMeClear then all of the associates and Specialists can use the same membership. Let that sink in! Thank you to Jorge for this awesome deal. https://youtu.be/pfuG8Q08rck Click here to check out a sample report / example treatment plan letter produced using MakeMeClear. I am joined by Dr Jorge Cardoso, founder of MakeMeClear, to discuss: How and When to Write Letters to patients – is it always? What about when there is more than one option – how can you put that in a treatment plan letter without it being confusing? What is the role of digital smile simulation images? What is you give a ‘global fee’ or ‘ballpark figure’ but things turn out more complex than anticipated? So many great themes of challenges with comprehensive Dentistry discussed with Jorge. If you missed his eBook I gave out in the last episode, check out 16 Steps to get More Treatment Plans Accepted Today. If you enjoyed this episode, you will love Think Comprehensive with Zak Kara.

Do you make ‘shotgun’ treatment plans? A shotgun treatment plan is like a shotgun wedding. It is rushed, on-the-spot and poorly consented.. https://youtu.be/mAnXcTUdFuM Shotgun Treatment plan vs being Comprehensive I am back with a Fan favourite – Dr Zak Kara who absolutely bamboozled with his communication gems from episode 10 (must listen if you have not already!) In this mammoth 80 minute episode we dissect how to PRESENT treatment plans to patients. Should we use their chart? Should they get a quote for extensive work at Day 1? Should it be at a second visit or all at their first visit (after all…this what they expect from us, right?) Do we need a separate consultation room (LOL)? https://youtu.be/cFHE2nnCM5E FULL episodes only on the main website and on Dentinal Tubules for CPD/CE Protrusive Dental Pearl 1: ebook Download for 16 Steps to get more Treatment Plans Accepted Today Protrusive Dental Pearl 2: Thank you for Mini Smile Makeover Composite Course and Enlighten Smiles for sponsoring this episode! I talked about my favourite composite instrument I learnt about from attending Mini Smile Makeover – it is called the CASI 3C and it is the perfect non-stick instrument for anterior bonding. Those in the UK can get this from Enlighten Smiles, and those in the USA or Worldwide can get it from their Cosmedent supplier. https://youtu.be/Ob9srJZu3hM The CASI 3C We also discussing about getting comfortable talking finance with patients – what are our limiting beliefs about money and fees? Is that holding us back? It did haunt me for many years… Do we need to give exhaustive documentation afterwards? What is the point of all this? What is the patient and you do not share the same ethos and values? This is the App Dr Zak Kara mentioned he uses: DDS GP only on the App Store What I loved about the episode was learning why Zak DOES give an itemised plan for Phase 1 treatment, but not Phase 2 or 3: https://youtu.be/plIpA6AjtBg If you gained value from this episode, be sure to subscribe and share it with a friend! If you enjoyed this, you will of course love Zak’s first episode on Protrusive: Think Comprehensive!

Periodontology has some good studies and evidence base – but what is the current thinking in the role of occlusion/parafunction in the aetiology and progress of periodontal diseases? I am joined by Specialist Periodontist, London-based Dr Richard Horwitz to discuss exactly the correlation and link between occlusion and periodontitis. https://youtu.be/QhZfDxR4SoY Are those with Anterior Open Bites more likely get to get Perio? Full video episode out soon. This episode’s Protrusive Dental Pearl I picked up from Dr Dipesh Parmar on his fantastic Composite course Mini Smile Makeover – it is to use a sectional posterior matrix band (like the B100 from Garrison or Tor VM) in a vertical fashion to create perfect mesial and distal contours for your anterior composite restorations such as Class IVs. Maestro Dipesh Parmar teaching Composites I also revealed that the team at Doctify are offering all listeners to this podcast 50% off for the first 4 months – you just need to tell them you listen to Protrusive Dental Podcast. https://youtu.be/bpBSFyCFrN0 Full video episode with Richard’s cases – only on the website and on Dentinal Tubules I had a really fun chat with Richard which included so much: When and why would you consider occlusal adjustment/equilibration in a periodontally compromised patient, perhaps to reduce occlusal trauma? Can Periodontal splinting help in these parafunctional patients? How can you check for fremitus? What role can appliances have in the stabilised periodontal patient? Listen to how I ruined Richard’s canine guidance! If you enjoyed this episode, you will like my episode with Endodontist Kreena Patel on Cracked Teeth!

We think we know what a tooth looks like….but most of the restorations that we see on a daily basis…how many of them have truly natural or morphologically correct tooth anatomy? I am joined by Dr Jurgita Sybaite who is the undisputed Queen of Tooth Anatomy! (Full video on main website) She works with Dr Basil Mizrahi and is passionate about Restorative Dentistry. https://www.youtube.com/watch?v=70KQXO9CGkY Full Episode only on Protrusive.co.uk The Protrusive Dental Pearl for this episode is to use a Thermacut bur (by Dentsply) to remove the interdental papilla when managing very deep, subgingival caries – an example case was posted on Instagram and Facebook for you to see how this works. https://youtu.be/thz07JOrDts What does Brad Pitt have to do with Tooth Morphology?! The three steps to learning and mastering anatomy: learn, draw, sculpt! What if you cannot draw? What tips would you give to anyone to improve their morphology (anterior and / or posterior) I play devil’s advocate – is knowing anatomy THAT important now with digital wax ups and tooth libraries? Should we really invest our valuable time with Tooth Morphology? Which is the best way to learn, additive or reductive? Wax? Soap bar? Do we need to master tooth anatomy if we are not a ‘cosmetic dentist’? Do check out Jurgita’s Instagram profile to see clips of her producing stunning anatomy! She also is a prominent teacher in this field – check out her website! https://youtu.be/9sTqKOznXpA Do we need to learn Tooth Morphology that well? Now we have Digital Tooth Libraries…? See what Jurgita has to say If you enjoyed this episode, check out Composite vs Ceramic with Dr Chris Orr. As always, hit subscribe on your podcast platform and leave a review on Apple Podcasts!

Interproximal reduction (IPR) is a useful way to create space in Orthodontics, but it has to be performed carefully to make sure it looks good and is effective. If you are new to Orthodontics or have never performed IPR before – this episode is for you. I am joined by Dr Devaki Patel, specialist Orthodontist, to discuss IPR techniques and the nitty-gritty details and answer the questions you always wanted to ask about IPR…but never did! https://www.youtube.com/watch?v=v9dAcHtPiCU&ab GDP Orthodontics has boomed in the last 10 years. More and more of us are treating orthodontic cases and often this may be referred to as Short Term Orthodontics (STO), or Anterior Alignment Orthodontics (AAO). Protrusive Dental Pearl: If you view a ClinCheck or a similar 3D simulation, make sure that the initial bite/occlusion is set yup correctly. You will be surprised in how many cases this may be wrong and it has not been picked up! If you are starting out with Ortho cases, IPR may be something that worries you. You may have questions like: Which are the best strips? Are strips better than a bur? How should you hold/orientate your bur? How do you perform IPR when there is crowding? What are the secondary benefits of IPR? Should you place fluoride after, or is that overkill? A really great and helpful guide to IPR ipr-orthodontics-guide-dentistsDownload If you enjoyed this orthodontic episode, you may also enjoy my episode with Dr Almuzian on whether Class I molars are really that important? I appreciate you all listening – do subscribe on your preferred podcast platform so that you do not miss the latest episodes.

I am joined by a young Dentist, James Martin, who started a really cool Facebook group called Dentists Who Invest. Well, if there is a group dedicated to Dentists who own Air fryers, then James’ group definitely has a need! The advice we share on this podcast is aimed at Dentists who have no clue about Investing. Forget dental school, but even in our general education we are not taught personal finance and investments. https://www.youtube.com/watch?v=UHpkM-9Vg94 Protrusive Dental Pearl: have you been a victim to ‘lifestyle creep’? This is when your income increases, your lifestyle and expenditure also increases. This is all good and well, but it is so important to watch your savings rate (how much money you save). Here are the 5 topics we cover in this episode aiming to improve your financial literacy: 1) How to get started with Investing?We share our individual journeys. His involves cryptocurrency, and mine involves accidentally stumbling upon Tony Robbins’ book about financial freedom! 2) DIY vs Financial Advisor/Investment Broker. The Pros and Cons of doing it yourself vs picking a portfolio with an investments company 3) What is the best investment? Stocks? Real Estate? Cryptocurrency? Bank accounts? 4) WHEN should you start investing? 5) What other piece of advice do you give for Dentists looking to invest? If you enjoyed this episode, do check out Personal Branding for Dentists with Shaz Memon!

I want to talk about maximising your learning potential from all the courses that you attend, but particularly the online ones. I was inspired from listening to a book called Limitless by Jim Kwik (check it out if you’re in to maximising your potential and the human mind). It had so many gems in there which I thought would be so useful for Dentists to learn when we’re attending courses so they have more impact on us. https://www.youtube.com/watch?v=F6Qc0BwTGRU More importantly, now that with COVID-19, a lot of the education is going online. You now commonly hear the phrase “I’m webinared out” – we are attending too many webinars and are itching for in-person courses again. Over lockdown it was definitely the case, you could fill your whole day with webinars during lockdown. That just gave us digital fatigue. I want to refresh and recap on what are the ways that you can maximise your learning while you’re on dental courses, but particularly on the online courses, so you don’t feel “webinared out” or “digital fatigue”. We can apply this to any online education – in fact, as a Dentist you probably already subscribe to membership only platforms for dental education. However, like many of us in our busy lives, you may be guilty of not giving these platforms enough time to gain from them. It is so important to make time to actually watch that content and actually immerse yourself in that content. I like to call this ‘protected time’. Time is scarce. This is why when you do find time to watch these videos on the online platforms or actually attend these webinars, your time is so valuable. You really have to maximise what you gain for every single course that you do, and every single video that you watch, and every minute that you invest in them. This is why I want to share the FAST protocol to maximise your learning, inspired by Jim Kwik and Limitless. F = Forget A = Action S = State T = Teach F stands for forget, which sounds crazy. Let’s imagine you’re doing a course on veneers – maybe a webinar or an online course on veneers. The way to maximise how much you learn from that particular course is to forget everything you know about veneers. One of my favourite quotes is from someone called Malcolm Forbes, and it’s “the role of education is to replace an empty mind with an open one”. The A stands for action, and it can also be interpreted as active learning. For me, it’s definitely the case that I learn better when I’m taking notes. One thing that Jim Kwik teaches is that we do not learn from consuming. We learn from creating. When I’m creating notes, or when I’m creating mind maps, and some people like typing manually on their iPads or on their laptops, basically almost transcribing what the lecturer is saying… you gain so much more from that process! So note taking or whatever you need to do (whatever creative way that you learn), it’s so important to have that rather than just consuming blindly or consuming blankly, you need to be able to create and that way you will learn more. The other thing that comes with active learning is that multitasking is an absolute myth. We can’t multitask effectively. For example, have you ever been on a course and maybe you’re sat in the front row with all good intentions…but what happens is that you get a text message from your practice manager or patient emails you and now your attention is completely somewhere else. And now you’re dealing with a staffing issue or a patient issue. Of course then you leave the the course to make a phone call. You’re now dealing with the patient or the staffing issue. You’re absent from the course. It’s basically that you’re trying to juggle a few things at the same time, and it’s just not going to work. You’re not going to maximise your learning potential. You have to focus intensely on that course in front of you and forget everything else. Forget the distractions. As humans, we can’t process a negative. Because we can’t process a negative, if something pops up in your mind or you get an email. You can’t just be like “okay, I’m not gonna think about this..”. The best way to handle that situation is make a note of it somewhere or make a to do list, focusing on that task at hand, and then move on from it. The S is super important for all realms, but particularly online. And the S stands for state. That means your environment, your emotional state, and also physical state (what is your posture like as you read this?). Are you doing an online course or webinar, in your PJs, lying down in bed, sideways? It’s not going to make sense compared to working in a home-office, far away from the kids (as far as you can be!). Your posture is important. If you’re slouching on the laptop, your ph

Get ready for the best summary of bridges you ever heard, including diving deep in to this mystical design of bridgework called ‘fixed-movable’ bridge. You cannot search about Bridge Design on Google without landing on the great content that Prof Paul Tipton has released. https://youtu.be/h9mmRiFtHmU Protrusive Dental Pearl: where to place your grooves for crowns and bridges?Crowns: place grooves mesial or distal, or mesial AND distal. Ideally in tooth and not in core material (we elaborate in the episode). Why mesial and distal for crowns and bridges? The forces will be transmitted bucco-lingually on a crown – therefore grooves perpendicular to this force vector to resist it would be mesial/distal. How about for bridges then? For conventional bridges the grooves are placed buccal or lingual, or buccal AND lingual. This is because the forces are now acting antero-posteriorly on the bridge via forces on the pontic(s). The buccal/lingual grooves will resist antero-posterior forces. Prof Tipton and I discuss: The benefits of fixed-movable bridges (such as negating the need for parallel preps of abutments) The contraindications of Fixed-Moveable bridges (such mobility of abutments) Why fixed-moveable bridges should be the default design Myth-busting Ante’s law What is the maximum span of fixed-moveable bridgework? What are the rules that govern cantilever bridges? what about mesial cantilever vs distal cantilever? Why is Distal cantilever worse, and is there any evidence to back this up? The steps in planning for Bridges: 1. Design anterior bridgework first 2. Choose your abutment teeth 3. What Design? (F-F, F-M, Cantilever?) and 4. Type of retainers for the abutments (Adhesive retainer, conventional crown, onlay etc) We discuss an actual case and live planning for a Fixed-Movable bridge Where is the fixed-movable attachment housed? Anterior or posterior? Inside the abutment or outside of it? The one thing you must do when placing Fixed-moveable bridges or you would have wasted the time and effort:Remove a small portion of the male component – about 0.25mm on average If you enjoyed this episode, you will like the complete denture tips given by Dr Mark Bishop – check it out! To learn more about Tipton Training, check out their website for courses.

One night when Dr Rajiv Ruwala was up all night as his daughter would not sleep…he came up with a very inspired list… He was interviewing Dentists for associate positions and asked himself, ‘What are the habits of the most successful and valued Dentists?’ He came up with this awesome list which we discuss point-by-point in this episode of the podcast: https://www.youtube.com/watch?v=NJeMUF05T18 Here are the 10 habits below: They can listen to the patients story and find a treatment to become a solution for the patient. I asked Rajiv if he has any tips in encouraging patients to tell their story or their goal? They often do not offer this info up front. They are proactive in recommending treatment, not reactive. I asked Rajiv to give a tangible example of being proactive. I also asked how to handle the situation when a proactive Dentist inherits the list of a reactive Dentist. They don’t get validation from how much patients pay them, but from how much the patient values what they have to say. If the patients value what the dentist has to say, they naturally accept the treatment. How do we serve patients who do not value Dentistry? They work with their nurses to make sure everything is ready and set up before the patient enters the room. The value of a great nurse is monumental – are you a checklist kinda guy? You may be surprised by the answer he gives… They do not moan about their working environment, the “system” or their staff, they help find solutions to problems and improve the situation. I like this because I always like to approach people or managers with solutions not problems. Rajiv has lots of solutions to work effectively in the NHS. They are happy to refer out and develop a skill/niche that allows people to refer to them. I have my views on this but how do you think one should find their niche? Rajiv gives his ideas. They don’t ask for something for nothing. Instead they build value before investing/ asking for investment. This is massive. How can you build value in to the care you provide? They look to improve in three key areas; clinically, financially, and personal growth, and aren’t afraid to ask for help to do this. Tell us how you, Rajiv, have looked to improve in those 3 domains for inspiration? They are not adversaries, they want to associate/collaborate. I find most successful dentists are so willing to share and help! They take adequate time off to be fully charged/energised. How much time off do you recommend, or is it personal?How about 10,000 rule when you are newly qualified? Rajiv talked about courses for communication which also features making the NHS system work, rather than moaning about it! You can find out more about that here: Course for Associates – PYP course Course for Principals – KYN course If you would like to pre-register for the Splint Course (limited delegates to allow mentoring and support), please subscribe for updates and surprises if you are looking for a comprehensive, step-by-step, clinical splint course.

As Dentists we do not treat headaches – however, we can manage the parafunctional forces and you will be amazed at how many patients will reduce their use of analgesics after these appliances. This is the big one….we finally delve deeper in to Anterior appliances as part of Splintember! https://www.youtube.com/watch?v=0jX7mB_jDKc Lets talk about these really evil devices [/sarcasm] – the anterior only or segmental appliances, the ones dental school told me to stay away from… There are lots of names/derivatives/ and brands for these such as: B splint or Dawson B splint NTI /SCi/Mci Bitesoft FOS E-splint named after Jimmy Eubank DAASA or the umbrella term for this splint family which is called AMPSA I have decided the only way to make this work for those that listen to the podcast on your commutes and while you garden is that I will urge you to go on to the Protrusive Dental Community where I will post example photos and videos of the various appliances. If you have not listened to Episode 8 with one of my mentors Barry Glassman – I really urge you to, we talk about these appliances and whether or not they cause an anterior open bites. In a nutshell – many dentists condemn this appliance. They believe that by having a splint only on the front teeth, that the back teeth will over-erupt or dentoalveolar compensation will take place. Does that happen? – NO, they do not tend to cause a Dahl effect for the following reasons: AMPSAs are only worn during sleep Dahl effect you need bone deposition – its not going to happen from 8 hours a night! I was careful with my words, I specifically said they do not cause an AOBs due to the Dahl effect. Technically, ANY appliance can cause an AOB due to muscle deprogramming and condylar repositioning +/- postural changes depending on which camp you believe in. You can actually predict which are the patients this might happen to – once again, from any appliance, but because the anterior ones are more efficient at relaxing the lateral pterygoids, this is why they are implicated for it. How does it work and which records do you need? The way it works is similar to the concepts or rationale of anterior guidance which I discussed in the previous episode. By not involving the back teeth – you are furthest away from that powerful nutcracker AKA the TMJ, and also due to the proprioception from anteriors, you are able to switch off the anterior temporalis muscles. What does this mean? What records do you need? Why do I like leaf gauges? Find out all in this episode of the podcast – I will go even deeper with Part 2 – watch this space! If you would like to join us for Occlusion2020 Virtual 2 day intensive program on 27th and 28th November, there are a few tickets left! Join me in Part 2 where we will talk about: Deciding upper arch or lower arch, or sometimes both arches What is the difference between these various anterior appliances and is one better than the other? Why even an AMPSA can be an overkill and which patients may actually benefit from simpler devices How many of my patients have developed AOBs, which splints caused them, and how to manage such a scenario

Michigan Splints AKA Stabilization Splints are the ‘gold standard’ occlusal splint according to many occlusal camps. https://www.youtube.com/watch?v=DIfqn2Zkjp0 Check out the Youtube channel for video versions of the podcast. At 10 minute mark there is an error – I showed a Facebow being used whilst talking about Leaf Gauges. Dental School told me that this Splint is the only one I will need to know and it will cure all. If this does not work…maybe the patient has ‘atypical facial pain’ 😉 Now before you all attack me…. I have to confess. It is actually a great all-rounder splint – but there are some key reasons why Michigan appliances (or Tanner for the lower) is massively overrated! Listen to this episode as I cover: What is a Michigan splint? How does this splint work? What records do you need for a Michigan splint? Do you need a Facebow? What are the limitations of Michigan occlusal splints? Why might other splints be better for many scenarios? Why you should be careful prescribing Michigan splints to primary clenchers Protrusive Dental Pearls were sent in by fellow listeners regarding patient care and rubber dam hole spacing. Have you checked out the rest of the episodes from Splintember? Here is a rough transcript: Lets face it – Dental school barely scratched the surface in a lot of areas, including Occlusion and splints – so it should come as no surprise to you that Michigans splints are not as great as you were taught they were. Michigan splints are actually a really good all rounder splint for all the main diagnoses within ‘TMD’ – quite often when I find a tricky case and I am unsure if the issue is more muscle or joint, I will recommend a Michigan – but still, it is a massively overrated appliance and is totally overkill for most of our patients. Lets start the basics – what is a Michigan splint? It is classically a hard upper splint.The lower is called a Tanner. Aka Stabilisation splint. It’s a centric relation appliance. What does this mean? I explain in the podcast (so listen up!). I go in to this appliance in a lot more detail and all the shortcomings. Fellow geeks, to conclude: It’s a great all rounders splint. And if ever you’re unsure of joint vs muscle diagnosis and you can convince your patient to spend hours in the chair, spend that money and you think they’ll comply, then go for it. It’s a great splint. But if you’re more concerned that your diagnosis is muscular, or the asymptomatic patient, and perhaps as an appliance to deprogram your patient….there are definitely more efficient ways to deprogram your patient. And that’s exactly what we’ll talk about at the next episode….stay tuned for the rest of Splintember!

Why do some patients have painful joints, whereas others get headaches? And why do MOST of our parafunctional patients not get any symptoms at all? Why do some peoples teeth wear away, whilst others teeth are riddled in cracks? https://www.youtube.com/watch?v=amdss07uN9s In this episode, I talk about the pros and cons of devoting your career in Dentistry to treating Temporomandibular disorders. Treating ‘TMD’ can be a complex field because it deals with all the complexities of chronic pain. However, it can be a very rewarding area. I also discussed why the umbrella term of ‘TMD’ is not really specific enough. We can do better as a profession to understand the diagnoses within ‘TMD’ a little better. Protrusive Dental Pearl: check out the Otter app for transcribing your voice, lectures or any audio/video! This is great for anyone who wants to convert audio in to notes, for students, and for content creators. I have uploaded the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) PDF file on to the Protrusive Dental Community group as promised to the listeners. If you enjoyed this episode, check out Myth Busting Occlusion and TMD with Dr Barry Glassman.

2021 UPDATE: This blew up! I was inspired to create a flowchart to help with Splint Decision Making – download the flowchart by clicking here Which is the BEST Dental Splint? https://www.youtube.com/watch?v=BsXjNkmQf9s Best splint on YouTube – or listen on the usual podcast channels It is finally SPLINTEMBER and we kick it off with an all time important question – which is the best splint for your parafunctional/bruxist/TMD patient? Surely it’s a Michigan…right? Or maybe it’s a Gelb appliance? Or the humble soft splint…? Did I just say that?SURELY it’s a A- Splint, B-Splint or a C-Splint?! Well, I have an answer for you…it’s called the G-Splint! The G-Splint* is the best dental splint there is. There are so many factors that will determine this. In this episode, Dr Jaz Gulati explores many of the factors to consider for appliance therapy in the form of dental splints: What are you trying to achieve? Is the patient symptomatic? What is the ‘purpose’ of the splint? (Hat tip to Dr Michael Melkers) What is the goal? What about access, cost, airway, orthodontics and compliance with splints? Protrusive Dental Pearl: A quick way to remove temporary crowns and onlays using a haemostat! Tune in for the rest of Splintember where I will go deep in to different splints! *The G-Splint is just a metaphor for splint provision based on the history, exam and diagnosis for your patient! Remember to hit subscribe for updates and join the newsletter on www.protrusive.co.uk

It is the one you have been patiently waiting for since I announced it on Instagram….Personal Branding with Shaz Memon who wrote the BOOK ‘Instagram for Dentists’. https://youtu.be/R9tU-lLlLlY What Shaz, from Digimax Dental, does not know about branding as a Dentist is not worth knowing. Protrusive Dental Pearl: Are you Google-able? Are you one page 1 of Google when patients and potential patients search for you? This is so important and is the reason companies pay MILLIONS for ‘Search Engine Optimisation’ or ‘SEO’ (not to be confused with SOE Exact!). A great way for Dentists to harness the power of being found in Google is to collect verified patient reviews using Doctify Collect verified reviews and add a widget to your clinician website Join our interview where I probe Shaz about all things personal branding: Should you have a logo as a Dentist? Learn about the hilarious error I made with an old, secret, stashed-away and destroyed logo that I am embarrassed about now! Is a Dentist website page, independent to the practice website, appropriate? What does Shaz think about doing it on the cheap via Fiverr or Canva? What makes a good dental website – BONUS: Shaz critiques my website (completely unexpected!) What are they keys to success for branding yourself online? The funny thing is that all the advice Shaz gave me on my Dentist website …I have still not updated/improved it based on his advice. That is one of the pitfalls of doing everything yourself. Getting the advice, unscripted and ‘live’ during the show was the highlight of the episode! If you enjoyed this episode, please support the podcast by subscribing so I can continue to make this type of content!

In this episode we listen to Alan’s story. His name is Alan Burgin and he’s also known as The Cornish Dentist on Instagram. https://youtu.be/oF-yyrwPfm4 His story involves themes of mentorship, challenges, overcoming adversity, gaining a work life balance, (so actually going abroad to Australia for six months)….I don’t give too much of the story away, but it involves so many real-world themes. And actually, it also involves a bit of luck and something that we touched on in Episode 34 with Richard Porter on emotional intelligence was the element of luck in your career trajectory is actually very important. The Protrusive Dental Pearl is about how to make cementing crowns less messy using Vaseline! I hope you enjoy listening to our reflective chat! NEXT MONTH will be Splintember! I will cover all things dental splints to simplify this confusing area of Dentistry. Listen to the FULL episode via direct download or via the following platforms: Spotify Apple Google Podcast Subscribe on Android

Case Acceptance – sounds dirty doesn’t it? Well its kind of important. We can make a huge difference to the lives of our patients and do more of the Dentistry we love to do. But only if your patient sees value in your treatment plan and believes you are the right Dentist with the right solutions. I spoke with Dr Gurs Sehmi who shared all his secrets! (I kind of forced it out of him!) The protrusive dental pearl for the episode is a video I shared on Protrusive Dental Community (FB page) using a Endodontic tool to squirt peroxide gel deep in to the access cavity to treat an internal bleaching case (see images below!): Before internal bleaching. UR1 sustained trauma – it was root filled with an MTA plug and GP by my Endodontist, Dr Cesar Munoz After internal bleaching. What a difference! Unfortunately no Video podcast for this episode (technical error on my part!) but for anyone inspired by Dr Gurs Sehmi’s protocols, do check out what he has to share: Here is the link to register for the mentoring program: https://accelerator.dentalnotebox.com/ This is a link where people can sign up for live cases https://dr-gurs-sehmi.lpages.co/live-case-stream The Dental Notebox Instagram/ FB link is: https://www.instagram.com/dentalnotebox/ https://www.facebook.com/DentalNoteBox/ If you like this episode, you will love Communication gems with Dr Zak Kara!

If there is one piece of content I produce in my LIFE which I think MAY have a massive impact on your life – it might not get much bigger than this one right here! I will put the video up shortly, but you can catch it on Facebook premiere tonight at 8pm on Protrusive Dental Podcast Facebook Page. Video: https://www.youtube.com/watch?v=HZ8yKV0MTr4 Do your grades at dental school influence your success as a Dentist?Is your IQ important? I would be surprised if any of you answered ‘yes’ for these questions. So what do Richard Porter and I believe is the most important predictor of success in your life, relationships and work? Two words: Emotional Intelligence. Find a quiet place, close your eyes* and take a dive in to the world of Emotional Intelligence as applied to Dentistry: *not while driving!! We discuss: How important is luck in your life and career What is emotional intelligence and what tangible examples can Richard provide relevant to Dentistry? Why does high emotional intelligence mean more ‘successful’ and even higher earning Dentists? Are you born with Emotional Intelligence, or can you improve your EQ? Why is Emotional Intelligence important for Dentists, Dental Therapists and the entire dental team? How can you find out your level of EI? Richard suggested The Big 5 Ocean Assessment – such as understandmyself.com Resources as promised: Harvard Happiness StudyDunedin study Learn with Richard Porter and Aspire If you liked this episode, you will love 12 Rules for Dentistry

At Dental School I was taught that we have 2 opportunities as clinicians to save a patient’s life. One was mouth cancer diagnosis (obviously) and the other was a patient with GORD who may develop Barrett’s Oesophagus. However, as I look back now, I do believe dental school missed something out….and that is Sleep Disordered Breathing (SDB). There is no formal acknowledgement of Airway in the dental curriculum. https://youtu.be/TKiX-J046JA Full Episode on the YouTube channel and soon to be on Dentinal Tubules for 1 hour of Enhanced CPD/CE What you will learn from this episode with a leader in this field Prof Ama Johal is that a team approach is needed. If the Sleep Physician is Team Leader, we as Dentists are SECOND in the pecking order, above ENT! That signifies the massive role we have to play in treating SDB. We discuss: How and why did Prof Ama Johal get in to this micro-niche of Airway within Dentistry Brief overview of anatomy with the ‘party balloon’ analogy What is Dental sleep medicine? What is sleep disordered breathing and sleep apnoea What is the contribution we can make in the dental profession? Is it just mandibular advancement splints? What is a CPAP What is the effectiveness or oral appliances vs CPAP? Why is the training at undergraduate level in both MEDICINE and DENTISTRY lacking? What are the barriers to Dentists who want to help patients with Sleep disordered breathing? How can we significantly improve the lives of some of our patients? What is the association between parafunction and sleep disordered breathing Should YOU get involved in treating the airway for your dental patients? Does premolar extraction orthodontics adversely affect the airway? What about children with massive tonsils/adenoids causing airway obstruction? Prof Ama Johal is highly regarded within Orthodontics and dentistry, for the standard of his clinical work and published research. He is the Vice President of the British Society of Dental Sleep Medicine (BSDSM) and Professor at Bart’s and The London School of Medicine and Dentistry. Resources and Downloads: British Society of Dental Sleep Medicine S4S Course Snoring & Obstructive Sleep Apnoea – a Role for the GDP – listeners of the podcast can get 50% until the end of August 2020 – use coupon code ME50 (this is not an affiliate link and I do not get commission from this – I am thankful to S4S for offering this to the community)

Dental Recruitment is Changing! https://youtu.be/1WmvW9-1YWE Would you rather work in a lavish dental clinic with all the bells and whistles, but with a high turnover of nurses and lacking a culture or ethos…OR, work in a ‘mediocre’ clinic with happy staff and a thriving culture? What makes an awesome dental practice, and how can associates and therapists find them? Where are they hiding? Are they as rare as a ‘good associate’? What is that even about? In the latest episode I chat with Andy Saunders and Simon Tucker about how dental recruitment has evolved – it is a purpose built episode if you are looking for a new opportunity or even if you are a principal looking to hire the right team member. We discuss: Why traditional methods of hiring Dentists, Therapists and Nurses may not be effective or good value any more The three types of CVs you need The power of the Video CV Importance of the same values within the team How to find your ‘tribe’ and the practice you belong in (and why you cannot just go by what their website looks like) The features and indicators we SHOULD be looking for in a new practice If you like the new face of dental recruitment (or finally, just a face!) and want Andy and Openwide to help you, reach out to Andy!

I left you on a bit of a cliffhanger last episode – but now you can finish off Andy’s ‘origin story’ of Posterior Guided Occlusion (PGO) and understand how this is practically implemented on patients. If you missed Part 1 and the ebook by Dr Andy Toy, check it out. https://youtu.be/WJxr1JPpDO0 The Protrusive Dental Pearl for this episode is continuing on the theme of Dental Photography I have been posting about on my Instagram. When taking portrait photos for your patients with a ring flash, point the ring flash at the ceiling, rather than at the patient’s face. This creates a softer, nicer image! If you missed out on my Butterfly Effect webinar, you can now check it out on www.protrusive.co.uk/butterfly – it’s about how seemingly small events in your career can compound and change the entire trajectory of your dental career. I added a new book to the book list – the Danish Way of Parenting! In this episode we discuss: Structural school of thought vs Functional school of thought The relationship between the condylar movement and the teeth The mathematical equation that is evidence for PGO I ask Andy questions to test PGO What does he mean by functional contacts? What is the healthy clench? We debate anterior guides vs posterior guides How does this apply to the patient with large masseter muscles who keeps breaking cusps? How many ‘centrums’ are enough? What Andy is prescribing in Clinchecks for the posterior occlusion How to finish the occlusion on an orthodontic case – and how Andy makes this ‘patient driven’ How Andy finishes 60% of his Invisalign cases with a ‘Dahl appliance’ Is Centric relation important to achieve? Andy tells us the birth of Canine Guidance

Do you worship canine guidance? I think I went through a phase where I placed a very high importance on the presence or absence of canine guidance. I then got thinking…how and why are my patients with AOBs doing just fine? Why is it that some studies suggest that only 5% of the population has canine guidance, and others suggest up to 60%? Is group function really the villain? This is why I am open to listening to theories that explain this. Posterior Guided Occlusion is one such theory. I am joined by Dr Andy Toy to explore PGO concepts I wanted to delve deep in to PGO – so we split this episode in to 2 parts. https://youtu.be/k6T8cbqSY1I What we cover in this episode: We hear Andy Toy’s stories How did he get in to ‘Posterior Guided Occlusion’, clear aligners and treating TMD? The journey that took him to Pankey The story of how Andy met Ron Presswood and the influence that he had in his views on Occlusion What is patient driven splint adjustment? Why was Andy getting good results with PGO splints, just as he did with traditional tanner appliances? Why are we trying to switch muscles off, but Andy is trying to switch them ‘on’!? The surprising origins of Bonwill’s Triangle What is a functional occlusion? Realising that the the quality of the evidence in Occlusion is poor Link to Dr Andy Toy’s eBook on PGO All the other downloads from every past episode is on the Protrusive Dental Community

Yes, you have read the title correct. I DID get Chris Orr on the Podcast…the silver lining of lockdown?! I am very excited to share this episode with you – Composite vs Ceramic, Direct vs Indirect. I have placed hundreds of humongous composites in my career that in hindsight should have been indirect restorations – I share the challenges that I faced in my journey and I am sure many of you will be able to resonate with it. https://www.youtube.com/watch?v=SGWcwkZD-kk We discuss: An extremely insightful episode with Dr Chris Orr (whom I refer to as ‘the Rockstar Dentist’ and I share the story WHY I give him this name) Is there a place for inlays? At what point does a composite become a ceramic (or read: direct becomes indirect) Is there a place for composite onlays? Does the parafunctional status of a patient influence the choice of restoration? Is eMax acceptable for 2nd molars? Dual cure cement vs light cure cement for onlays? How do you decide which cusps to cover? What kind of join is best to the tooth? Pressed eMax vs CAD/CAM eMax? What does Chris Orr think about BOPT/Vertipreps? As promised in the episode, if you are waiting for announcements of Advanced Dental Seminar courses by Dr Chris Orr – check out their ADS Facebook page