It Can't All Be Done With a Bur

Episode #333 with Dr. Jeff Rouse

Aesthetics should be the byproduct, not the driver of airway treatment. And a problem in dentistry is the pervasive camouflage treatment culture that many clinicians participate in. So, to expose the problems with this mindset, Kirk Behrendt brings in Dr. Jeff Rouse from Spear Education to teach you that not everything can be fixed with a bur; airway might be the answer. But don't just take any old course on sleep — sleep and airway are not the same thing! For more of Dr. Rouse’s advice, listen to Episode 333 of The Best Practices Show!

Main Takeaways:

Dentistry needs to go beyond the aesthetically-driven camouflage treatment culture.

Dentofacial growth problems need to be addressed, not camouflaged.

There are more than just structural and biologic issues; there's a bigger picture.

You can't solve airway issues with a bur, by cutting away and removing things.  

Comprehensive care isn't taught in dental school.

Don't just take any sleep course. Learn about airway.

Quotes:

“[Dr. Christian Coachman wrote in his post], ‘In my humble opinion, the main challenge of modern dentistry is, go beyond the aesthetically-driven camouflage treatment culture.’ And I totally agree. I wrote him and said that we need to also have ENTs and sleep physicians think the same way. . . His idea was, we need to stop just taking constricted arches and malocclusions and camouflaging it by adding veneers and crowns, that we need to get to the core problem, which is that we've got a dentofacial growth problem. And we need to address that.” (08:09—08:57)

“Dental school has a huge problem. And I don't think there's an answer to it, honestly. I can't figure an answer. If you turned a dental school over to me tomorrow, could I put a curriculum in that would advance our ability to treatment plan more ideally the way Christian was talking about? Absolutely. What would be the problem? Well, a lot of those treatment plans require multiple years, so you're not getting the hands-on. You're not actually cutting on teeth and stuff; you're doing other things. But even more important, it would require retraining all of the faculty. And every time a new faculty member came in, they'd have to be retrained all over again.” (09:52—10:36)

“At Spear, we teach that facially-generated treatment planning starts with esthetics; where do the teeth belong, like setting a denture; function, how do you put the lower denture in to get it to work right. Then, you talk about structural issues and biologic issues; do they have disease, did they break a tooth, what kind of ceramic I'm going to use. In dental school, we only talk structure and biology. There's no, ‘Where do the teeth belong?’ It is simply, get hand skills so that you're not going to hurt people when you leave. And do you need to do that? You absolutely do. The problem is, we call it “treatment plan”. They say, ‘Okay. You've met your new patient. Now, you're going to present your treatment plan to me.’ And that implies that it’s comprehensive in nature, and it’s not even close.” (10:41—11:33)

“We need to continue to spread the word that there's more than just structural and biologic issues. There's a bigger picture that needs to be taken into consideration.” (12:50—13:00)

“If the only thing a dentist knows how to do is cut with a bur, they don't understand the interdisciplinary nature of what they just put on the teeth. Then, they try to provide a solution simply by warping ceramic, building out huge bicuspids, teeth that are overlapped, ‘Well, if I prep this, it could do this and do that.’ I mean, they're always trying to figure out how to solve it with a bur. And what we’ve started to look at and look at differently is, if you take that case, and the...