Are you confident in replacing a single missing central incisor?

When is a denture the right option — and when should you consider a bridge or implant instead?

Why is the single central incisor one of the hardest teeth to replace to a patient’s satisfaction?

In this Back to Basics episode, Jaz and Protrusive Student Emma Hutchison explore the unique challenges of replacing a single central incisor. They break down when each option — denture, resin-bonded bridge, conventional bridge, or implant — is appropriate, and the biological and aesthetic factors that influence that decision.

They also share key communication strategies to help you manage expectations, guide patients through realistic treatment choices, and avoid disappointment when dealing with this most visible and demanding tooth.

Key Takeaways: 

Highlights of this episode:

00:00 Teaser

00:28 Intro

01:56 From Dental Nurse to Final-Year Student

07:38 Challenges and Considerations in Replacing Central Incisors

12:51 Patient Communication and Treatment Planning

18:33 Discussing Treatment Options and Enamel Considerations

21:16 Communicating Options and Guiding Patient Decisions

25:51 Choosing Between Fixed and Removable Options

27:10 Midroll

30:31 Choosing Between Fixed and Removable Options

31:05 Handling Old Crowns and Patient Communication

34:17 Conventional vs. Resin-Bonded Bridges

37:57 Occlusal Load, Function, and Implant Considerations

43:40 Digital Workflow in Dentistry

45:54 Managing Aesthetic Expectations

48:34 Final Thoughts and Recommendations

52:59 Outro

🎧 Want to feel confident with prosthodontics?

Explore these essential follow-ups to this episode:

Quick, practical lessons to sharpen your planning, communication, and anterior aesthetics — all in your pocket.

#ProsthoPerio #OcclusionTMDandSplints #Communication #BreadandButterDentistry

This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance. 

This episode meets GDC Outcomes C.

AGD Subject Code: 610 – Fixed Prosthodontics

Aim: To provide a clear, clinical overview of replacing a single missing incisor — focusing on when to choose a denture, bridge, or implant, and how to communicate realistic expectations.

Dentists will be able to –

What if one bad decision completely changed the course of your career?

In this exclusive, members-only episode, Jaz sits down with a fellow dentist from our community who shares his raw, honest story about a moment of misjudgment — committing fraud — and the painful lessons that followed.

This isn’t about blame. It’s about insight, accountability, and redemption.

From the shock of investigation and court hearings, to the struggle of rebuilding trust and identity, this conversation shines a light on what really happens behind closed doors when things go wrong.

The aim of this podcast was to hopefully deter colleagues from temptation which can affect anyone at any time.

This is a members-only podcast episode due to its sensitive nature.

You can access it by creating a free Community account at: https://www.protrusive.app

Highlights of this episode:

00:00 Teaser

00:49 Introduction

05:49 End Screen

Love this episode? Don’t miss Divorce, Alcohol and Rough Patches – Overcoming Adversities (IC040)

#PDPMainEpisodes #BeyondDentistry

This episode is eligible for 0.5 CE credits via the Quiz on Protrusive Guidance. 

This episode meets GDC Outcomes A and D

AGD Subject Code: 555 Ethics in Dentistry

Aim: To reflect on the ethical, professional, and emotional lessons learned from a real-life case of dental fraud, highlighting accountability, insight, and rehabilitation while identifying practical steps to prevent similar incidents.

Dentists will be able to –

Ever had a patient swear their bite feels “off” – even though the articulating paper marks look perfect and you’ve adjusted everything twice over? Or maybe you’ve placed a beautiful quadrant of onlays, only to have them return saying, “these three teeth still feel proud.” If that sounds familiar, you’re not alone.

In this episode, I’m joined (in my car, no less!) by Dr. Robert Kerstein, who was back in the UK to teach about digital occlusion and the power of the T-Scan and ‘disclusion time reduction therapy’. We dig into why a patient’s bite can still feel “off” even when everything looks right, how timing is just as important as force, and why splints and Botox don’t always solve TMD.

Robert explains why micro-occlusion is the real game-changer, how scanners could mislead you, and why dentistry still clings to articulating paper.

So if you’ve ever wondered why “perfect” cases still come back with bite complaints, or whether timing data can actually prevent fractures and headaches, this episode will give you plenty to chew on – pun intended.

Need to Read it? Check out the Full Episode Transcript below!

Key Takeaways:

Highlights of this episode:

If you want to get more clued up on TMD, tune into this episode for the latest insights and guidelines! PDP213 – TMD New Guidelines –  however be warned that the guidelines are contradictory to what Dr. Kerstein advises….ah the wonderful world of TMD!

 #OcclusionTMDandSplints #OrthoRestorative

This episode is eligible for 0.5 CE credit via the quiz on Protrusive Guidance.

This episode meets GDC Outcomes A, C.

AGD Subject Code: 250 – Clinical Dentistry (Occlusion/Restorative)

Aim: to explore the role of micro-occlusion and timing in TMD and restorative success, highlighting how tools like T-Scan provide data that other tools cannot. This episode seeks to give dentists practical insights into diagnosing, preventing, and treating occlusal problems with greater accuracy.

Dentists will be able to:

Teaser: Pressure is a force over surface area. And when it gives us the red, the blue, yellow, it's not measuring the force, so it cannot tell us the pressure. So tell us about what the nuances of being careful with the occlusogram and where it fails in the face of something more sophisticated, like the T-scan.

The essence of a scanning technology is that all the teeth are scanned with the patient’s teeth apart. No one’s biting. There’s no forces captured. There’s no contacts. There’s no gathering of teeth banging together or rubbing around. So it completely is falsely representing. These colour coded occlusograms have no force information in them at all.

Anyone who’s used articulating paper, which most of us do, and the T-scan, you still mark the teeth with paper, but you choose the contacts to treat based on the data, not based on where the paper marks look. And very often, the most pressure points of contacts are small, scratchy little marks that dentistry says are light force, which you’re completely wrong because again, the load is applied over area. So if you have a very small area, you have the potential for very high pressure.

Jaz’s Introduction:
Protruserati, the occlusogram is lying to us. Does that sound familiar? Well, we welcome back again, Dr. Robert Kerstein. If you remember way back in episode 109, we made an episode called, “Articulating Paper Is Lying to Us,” and you guys absolutely loved it because Arctic paper is lying to us.

You should totally listen to that episode if you haven’t already. And if you haven’t, essentially the arctic paper marks you see on teeth are flawed in the sense that you can’t look at a mark and accurately say that, oh yeah, that’s more force, or that’s less force, or that’s hitting first. You don’t get that data.

And not only that, but you also get false positives when it comes to articulating paper. Now, similarly, I’ve got Robert Kerstein back again talking about the occlusogram. Now the occlusogram is that heat map you see when you do a scan, when you do an intraoral scan of a patient, upper arch, lower arch, and then you do the occlusion.

Most modern scanners will give you some sort of a heat map of the occlusion and we call that an occlusogram. And we may all at the beginning make this mistake, this very simple error, that when you see red on the occlusogram that means high force. Well, we will absolutely and emphatically bust that myth today.

You see the heat map or the occlusogram is just a measure of proximity. How close in space is that cusp to that fossa? And if it’s very close, it’s gonna be red. And if it’s maybe a few microns away, it’ll be a colder colour. Absolutely does not tell you how much force or timing or pressure, none of that stuff. Just contact proximity. So we must be careful in how we interpret that data. It would be misinformation to tell a patient that a certain tooth is having more load because of the colour.

Hello Protruserati. I’m Jaz Gulati and welcome back to your favourite dental podcast. Today’s guest is none other than Dr. Robert Kerstein. Rob Kerstein is like the godfather of digital occlusion. When I was in New Mexico a few months ago with Dr. Bobby Supple, he described Dr. Kerstein as the Einstein of occlusion, and it’s an absolute pleasure to chat with him again.

It’s a different format of the podcast. We’re driving, well, I’m driving, he’s my passenger. And so one of the team members, when they were listening to this, they said, it’s like carpool karaoke vibes. And don’t worry, we will not start doing a little singing and dance in the middle of this episode, but something a bit different, a bit fresh. Me and Dr. Kerstein were on the way to some DTR training in the UK.

DTR is Disclusion Time Reduction, essentially, if you listen to that episode that we did with Nick Yiannios. We talked about frictional dental hypersensitivity, and essentially lots of friction between the back teeth could cause your teeth to become sensitive. So this posterior dental friction is also implicated in TMD, thus resurfacing that old debate: is occlusion a causative factor of TMD?

Now, we all know some CAMs and some reviews that suggest that occlusion has no relationship to TMD. Whereas my guest, Dr. Robert Kerstein, says that TMD is a neurological condition and has everything to do with occlusion, and particularly that muscular TMD group would greatly benefit from an occlusal adjustment or something to change about their occlusion, to reduce that sensory input and their noxious muscular spasms.

And I saw all this freehand. I can’t wait to share my experience of what I witnessed when Dr. Robert Kerstein came to my practice and I treated three patients. So I’ll leave you on that teaser if you like, ’cause we have another episode coming with Dr. Jeremy Bliss talking all about occlusion, TMD and Disclusion Time Reduction, aka DTR.

Dental Pearl
But for now, let’s enjoy this episode of occlusogram. And just before we join the main interview, I need to give you your Protrusive Dental Pearl. Every PDP episode, I’ll give you a top tip that you can use right away. And today’s one, like many pearls are, are from Dr. Mohammed Mozafari. Mohammed’s one of the most selfless and caring and giving people on our Protrusive app community, always helping our colleagues.

And today it was our good colleague Yazan. And just yesterday on the group, Yazan had a query. He’s got these crowns, definitive crowns, temporarily cemented with TempBond.

Now we all know of that scenario that it could have happened to you or a colleague, whereby you put these crowns in temporarily. Even some colleagues, they try in a crown, let’s say a PFM crown without any cement, and they put the crown on and they just cannot take it off, and it’s like impossible to get off.

It’s not happened to me yet, but I’ve heard of this happening many times. So quite appropriately, Yazan was right to ask on the group, what’s the best way to remove a definitive crown that’s been temporarily cemented? Because you want to remove it in a way that you don’t damage the porcelain or the material itself, and you want it to be nice and easy and not very uncomfortable for the patient whatsoever.

Now, what I was going to say before I read all the comments was there are these like special pliers you can get with these, like these plastic ends, but they can be a bit hit and miss. Sometimes they do slip off, like they have got this like textured surface to prevent the slippage, but it can slip off.

So I really like what Mohammed suggested. So Mohammed suggested you get some bite registration paste, you put some buccal and lingual of the crown, then you put some gauze over it. You obviously let that bite registration paste set a little bit, and then you can get your hemostat or your mosquitoes and squeeze and try and wiggle the crown off.

The benefit is that the gauze and the bite registration paste are kind to the crown, but at the same time giving you enough of a grip. Haven’t tried this exact way before, but it just sounds amazing to me, and Yazan was able to report back that he was able to get the crown off. So thank you again, Dr. Mozafari. Really appreciate all the help and support you give to all the community members on Protrusive Guidance. Let’s now join the main episode and I’ll catch you in the outro.

Main Episode:
Dr. Robert Kerstein has entered the UK once again and we’re doing an extremely rare driving podcast. So, Robert Kerstein, welcome back to the UK. How are you today?

[Robert]
I’m good. Thank you for having me.

[Jaz]
Absolute pleasure. You know so many dentists around the world, around the world.

[Robert]
Yes.

[Jaz]
And you’ve done these trainings where I’m sure you’ve sat in lots of dentists’ cars.

[Robert]
Yes.

[Jaz]
And so therefore, I want to start by apologizing for probably the worst car of a dentist you’ve ever sat.

[Robert]
Oh, it’s very nice.

[Jaz]
No, no, no. Listen guys, as you guys know, I’m not into my cars at all. I literally googled what’s the cheapest electric car I can go buy for tax efficiency, and I landed on this Chinese car, the MG ZS EV. So I was trying to start by apology, but one of my, like a slight detail for you, talk about the good stuff, is one of my philosophies in life when it comes to spending money is things that I don’t value and I don’t love, I always skimp on.

But things that I value, I will spend mercilessly. I will save mercilessly where I can, but I will spend lavishly on the things that I value. And so one of the things I value so much is education. Education and investing in myself, which goes back full circle to why you are here in the UK right now. Myself, Riaz Yar, Shreyas Mhatre, Haider Raza, and then of course the previous group that you trained are also part of this, and you’re gonna do this one week intense tour around the UK with a didactic day on Thursday.

And we’re talking about Disclusion Time Reduction and the use of T-scan and all the benefits. And so previously we’ve done the episode on “Articulating Paper Is Lying to Us” that had about thousands of hits. You also very kindly shared lots of papers and that link is still active. If someone wants to download the papers that you kindly shared, that link is active. So I’ll link that episode there.

But now that I’ve done like a little introduction, I want people to really understand the scale of your education, the mentoring that you’ve delivered over the years around the world, ’cause it truly is an international operation. So tell me, how far and wide does it take you? How many dentists have you trained and what are you actually training on to help the younger docs understand? What are you actually showing chairside to dentists?

[Robert]
Well, I’ve trained dentists in many countries, so I’ve been very lucky to travel the world, see dentistry in Korea and Thailand and Japan and Russia and Europe. Many dentists in the UK and the United States, South America, it’s really Canada. It’s hard to–

[Jaz]
India being a hotspot.

[Robert]
India, many dentists in India. And so, it’s been a unique experience for me, for sure. But what we teach, what I’m teaching, is how to use the T-scan technology chairside effectively, and Disclusion Time Reduction is specifically to treat TMD muscular patients and how effective it is at resolving it.

No appliances, no Botox, no TENS, no jaw repositioning, no appliances, no smaller guards, no acupuncture, no massage, no chiropractic care, no hypnotherapy. It’s the only treatment that’s neurologic, treats the central nervous system. That’s just why it resolves TMD, which is really the occlusal neurophysiology is at the core of TMD, even though there’s unfortunately many incorrect advocates around the world who keep teaching that occlusion has no role.

Occlusion is the number one cause of TMD, muscular TMD, and even some breakdown of the joints because of how the occlusion impacts disc position, lateral pterygoid strain, and therefore affecting the internal joint space.

[Jaz]
So what you’ll be teaching me today is we’ve got three patients booked in and some of these patients I’ve done orthodontic correction on because their occlusion was not conducive to any sort of immediate anterior canine guidance. It was a mess. So I’ve got a good foundation and that’s what you taught me is the macro occlusion.

What we’re dealing with today is the micro occlusion, not looking at just the dots and lines, but really the force and the timing being the most important thing, the timing. So as you said, and also something Nick Yiannios has also said recently to me is, as our jaw moves aside and there’s teeth contacts happening, they’re like little speed bumps. And so we want to eliminate these speed bumps.

Is that a good way to explain to a young doc who’s trying to understand what DTR is? ‘Cause trying to spread the message and patients will be tied up with this EMG, so muscle data coming from temporalis, masseter, anywhere else you can let us know now ’cause I’ve literally just got the kit in my car, haven’t opened it. So how’s a good analogy, a good way to explain to doctors what you’re training me on today?

[Robert]
Well, the speed bump analogy really discusses like the tooth contacts that rub together frictionally when people use their teeth. But it’s really the transfer of the neural information from the rubbing of the teeth through the pulp and the PDL that is what causes many occlusal problems.

And so the timing of that, the duration of these frictional speed bumps, if you will, sets off long periods of muscle firing. And the muscle firing is directly influenced by the teeth directly from the brain. There’s a single no-synapse pathway from the molars and the premolars, pulps and PDLs.

It goes directly to the centre of the brain and it enters a structure known as the reticular formation, which controls five or six different major body systems, mostly as it applies to this, your training today, is swallowing and masticating and pushing food down into your throat rather than into your lungs, because the teeth modulate all of those movements so that you don’t asphyxiate by putting food into your lungs.

So all these muscles that are involved in chewing, swallowing, and moving food into the digestive tract are controlled by the teeth. And this is why it goes on without us thinking about it. Nobody sits around and says, I’m gonna chew for a while and I think now I’ll swallow and maybe I’ll chew longer and no, I wanna swallow.

None of that happens. You’re just rubbing your teeth together and then all of this physiology takes place with neural control from the brain. And the tooth contacts can hyperfunction those muscles. So you can still use them to do all the things you’re supposed to do, but they get tired, they get sore.

They get tight because the tooth contacts create too much contraction information, and the Disclusion Time Reduction minimises the amount of contraction information that the teeth are passing on to the brain to control swallowing and moving food into the digestive tract with the least amount of muscle activity.

So when you disclude someone in a rapid timeframe, the least amount of muscle activity is used to perform these actions, and that allows the muscles involved to operate without pooling lactic acid, without becoming hyper-contracted. And then the symptoms that are associated with that: tight throat, facial pain, headaches, clenching and grinding, difficulty chewing, tired chewing, soreness after chewing, those things go away.

Because it’s neurologically resolved, not externally resolved with like splints and Botox and TENS and appliances. Those things don’t really work. They try to work, but they never stop the problem because the occlusion is still perpetuating all of this electrical activity that the brain is putting out into those muscles. So it’s a very powerful treatment. It controls how the central nervous system works, and that’s why it’s so effective.

[Jaz]
We were talking last night over dinner about centric relation, MIP now, but I would suggest that anyone interested in why the treatment we’re gonna be doing today is not an equilibration in the more traditional sense of seating the joints into centric relation and working from that position. The DTR is very much done, carried out, using MIP as a base.

And you covered that really well in the previous episode, but one thing I said to you last night is that, if only such a tiny percentage of the population are, have their centric relation coincident with their MIP, for example, as we know, then surely, why is that our goal? So we’re chasing the 1%, where actually we see physiologically that actually 99% plus are in MIP, which is further ahead, forward to their centric relation, right?

And so, but in the similar way, a lot of dentists may say to you, Robert, in terms of why maybe the number of T-scan users isn’t as great as other technology adoption, such as the intraoral scanner, for example. They’d be saying that, ah, I don’t need that level of precision because some dentists say that, accept what you say about MIP because of that.

Yeah, you’re right, because such few people are in centric relation and they’re doing just fine. We can and should work at MIP, it makes sense for the patient. But then a similar group of dentists might say that, do we really need that microsecond data because yes, there’s a frictional rubbing of the posterior teeth.

It is happening. But if you were to T-scan and analyse most people, most population, you would find that the majority, especially after a certain age, are in group function. You’d find that there would be these posterior contacts. So really what we need to fall back on is, okay, there is the kind of patients that come to us as TMD patients, they’ve kind of self-selected themselves as they’re beyond their adaptive capacity.

And then that’s the ones that this treatment modality is for. It’s not for the asymptomatic cohort. Am I right in saying these ramblings?

[Robert]
Well, it’s a very interesting point because a lot of occlusal problems are not chronic TMD. They’re wear, recession, abfraction, mobility, cracking of teeth, chipping of incisal edges, isolated areas of wear or periodontal problems that arise around certain teeth because of occlusal factors, and those people are not complaining about anything really. They’re just slowly destroying their teeth.

[Jaz]
Which is the majority actually. The silent majority.

[Robert]
Well, exactly, because they’re not in pain, but they’re still losing tooth structure or root structure.

[Jaz]
They have signs but no symptoms.

[Robert]
Yes. And those signs are damage and the same and over. Well, it’s perceived as overload by like vertically. They’re making too much force, but it’s actually not vertical. It’s lateral movements that destroy their teeth. Friction, rubbing of teeth, milling of teeth for fractions of seconds.

That then overload the teeth because muscle activity is raised. And so there’s a lot of advantage to treating the asymptomatic patient who has signs of occlusal wear or damage or roots, abfractions. And those things only progress. They don’t go away. They just get worse day to day. And people who don’t address it early on, 10 years later, have a lot worse of a problem and may need reconstructive dentistry.

So there is an advantage to treating people that demonstrate occlusal problems in the same way. Because by treating the disclusion time in those patients, then they use their teeth with a lot less muscle-applied force, because the muscle activity is cut way down.

That’s what Disclusion Time Reduction does, is it relaxes muscles, it stops hyper-contracting muscles, so the load to the teeth is then greatly minimised while someone uses their teeth, and then the processes of damage are arrested and, or let’s say tremendously minimised, as opposed to continuing to wear their teeth, sand their teeth away, chip their teeth, cause root damage.

And those things are often patients don’t treat them or bring them up because they’re not in pain, they just are destroying their teeth. So enzyme reduction.

[Jaz]
So that’s a proactive, preventive treatment. But I imagine most of the DTR that’s carried around the world is delivered to the symptomatic cohort. Because to the nature of them being self-selecting and actually coming and having the sort of mindset that, okay, I need treatment and I’m willing to invest in this treatment for the result.

Whereas trying to have that conversation, like trying to sell aesthetics to someone like, hey, let’s do veneers and stuff, and that kind of stuff might be actually easier to give ’em what they want rather than what they need is just so a psychology. So that’s why whilst, yeah, DTR would help asymptomatic cohorts, because when we look at occlusion and the chewing system long term over time, that this sets ’em up in a better way.

And that makes sense to me. But yeah, I think majority of DTR is probably delivered for the symptomatic individual because of the fact that they are the ones who selected themselves.

[Robert]
It’s treatment for the symptomatic patient, but the application is far-reaching. But most of the dental injuries sustained that are not traumatic, like getting hit in the face with an accident, the dental damage, I should say, you know, again, the same things: wear, recession–

[Jaz]
Microtrauma.

[Robert]
Is microtrauma and it comes from the overload that the lack of disclusion creates. And the disclusion, people often think they have disclusion. Dentists will say, yeah, this person has good anterior guidance, but it’s the first millimetre of movement on either side of the central fossa that matters.

It’s not that they disclude at the end of their excursion. No one is chewing food with canine-to-canine tip-to-tip. Nope. So the person has to disclude within a very short distance from leaving MIP in all directions, and that’s what controls the muscle activity. And that control can only come from computer analysis.

It isn’t possible for us to measure the kinds of pressures that go on in a very short distance. We can’t pick it up in any other way than using the T-scan sensor, which is a highly sophisticated electronic device that is used all over the world in many, many industries. Dentistry doesn’t understand that. Dentistry doesn’t seem to really want the T-scan to succeed. And many people talk it down, but it’s the most sophisticated engineering tool available to dentistry to manage occlusal problems.

[Jaz]
Well, talking of sophisticated tools, a lot of dentists, and then I love how you just came to the topic of this very short snippet today, is ’cause we’ll do some more content on Thursday and whatnot.

And today, hopefully I’ll get to record some of the DTR that we’re doing through my loupes actually, which will be pretty cool. But sophisticated technology, a lot of dentists, they feel that the data they see from an occlusogram–

So for the younger docs, occlusogram is when you take a scan, let’s say PrimeScan, iTero, 3Shape, whatever you use, and then you record the occlusion, and then you get this like heat map of occlusion, and some dentists may be fooled into thinking, why do I need the T-scan? Because this is telling me where the forces are highest. This is telling me already.

And then what we need to talk about is why, whilst that has some very basic data, we have to be careful how we interpret that data. And the example I want to start off with before I hear your sort of way you expect the dentist that, okay, just be careful with this occlusogram data.

But one of the cases that I teach in our foundational occlusion courses is a case where this lady, late fifties, early sixties, she had a history of having Invisalign, had a fixed retainer, and on the upper and behind the upper anteriors, and this fixed retainer snapped in half along the centrals.

And every time she bites together there is very clear fremitus, i.e. when she bites together, the front teeth literally move out the way, mobility, then the back teeth are able to come together, which makes sense as to why the wire fracture is, okay. So when you take the scan of that static position, when the teeth come together, you would see that, oh, everything looks okay.

Because what you’re seeing is the end product. Once the teeth are fully come together, once the front teeth have overloaded and moved out the way and the occlusogram would fool you into thinking that there is good distribution of load around the arch. But I think even the younger colleagues can understand that, in this example where we have fremitus, that actually that, how can that be true?

Because the front teeth were early contact, they had to move out of the way. And that’s not gonna be good for the PDL, ligament, long term. And then the back teeth were able to come together. But that story, that timing is not captured in occlusogram. It’s not telling us that kind of stuff.

And when I showed that case and how I treated it was we did some Invisalign, we gave the correct overjet to allow the jaw closure to happen. And then now, three years on, I checked the teeth now and they are solid, okay, because now, and then you look at the occlusogram, it doesn’t look much different.

But the first occlusogram and the second, they might look the same, but it’s the timing data you miss out on. And the force data is actually coming from how close the teeth are together, which is not telling you about the actual force itself because, as you said yesterday over dinner, pressure is a force over surface area. And when it gives us the red, the blue, yellow, it’s not measuring the force.

So it cannot tell us the pressure. So tell us about the nuances of being careful with the occlusogram and where it fails in the face of something more sophisticated, like the T-scan.

[Robert]
Well, the essence of a scanning technology is that all the teeth are scanned with the patient’s teeth apart, right? No one’s biting. And so there’s no forces captured. What happens is the software algorithmically puts the scans together spatially–

[Jaz]
Stitches them, yeah.

[Robert]
Right, spatially. But there’s no impact pressures. There’s no contacts. There’s no gathering of teeth banging together or rubbing around. So it completely is falsely representing. These colour coded occlusograms have no force information in them at all. And a recent study showed that clearly they don’t measure pressure.

There’s a comparison of the T-scan, force mapping to PrimeScan. And there was way too much overestimation of what appears to be high force in the PrimeScan. But it’s not force at all. It’s distance and tooth proximity, contact intimacy, which is not pressure.

And just because you have a good contact, low intimacy, meaning very small distance between opposing teeth, doesn’t mean that tooth generates extreme pressure. That’s a completely false representation that the scanning companies are proliferating and misleading dentists in a very unfortunate way because there’s no impact pressures captured when you scan someone because the teeth are all apart. So that’s a very big difference between–

[Jaz]
But what do you actually scan? The bite, the teeth have come together, and then held there, and then stitching that. But you’re right, because the actual arch itself is taking the arch in isolation, the lower arch in isolation, that’s scanned when the teeth are apart.

And therefore you don’t have the stressors into the teeth. And when the teeth do come together and you scan the left and right bite, and obviously teeth will intrude a bit, hence why you have like minus figures in terms of, someone has intrusion and whatnot, but that’s not giving you force and timing data.

So I think that a key lesson for dentists is don’t look at the occlusogram and start doing adjustments on teeth by occlusogram, thinking, oh, the first molars are looking red on the PrimeScan. That means they must be proud. I need to adjust. That would be a very false way to view it. Would you agree?

[Robert]
Yes, correct. Very, very true. Meaning it’s false. It’s the distance scale does not predict the pressure mapping. And that’s what scanning technology offers is distance between opposing teeth and you know how close or how far apart various surfaces are, and this is not gonna give you pressure mapping because no impact pressures are actually measured in any way at all. So it’s completely false when it comes to force, timing and pressure.

[Jaz]
So what are the benefits to actually measuring the pressure? So what decisions is a dentist able to make once they know about the timing and pressure data that they weren’t able to do before? Because before, without it, we’re relying on the occlusogram and relying on articulating paper. Now, we talked extensively about why the articulating paper is lying to us.

But feel free to revise those concepts for someone who may need to listen to it another time. But what’s the, I guess what I’m trying to say, what’s the advantage of, fair enough, we have data, but it’s the application and the use and how you choose to use the data to help benefit your patient. What is the benefit of the pressure data?

[Robert]
Well, it allows you to make intelligent decisions about what to adjust and what not to adjust, instead of looking at ink marks that don’t measure pressure at all, or scanning technology which doesn’t measure pressure at all, so that you treat very minimally and definitively without misrepresenting where you should be treating.

And of course, anyone who’s used articulating paper, which most of us do, and the T-scan, you still mark the teeth with paper, but you choose the contacts to treat based on the data, not based on the way the paper marks look. And very often the most pressure-responsive contacts are small, scratchy little marks that dentistry says are light force, which you’re completely wrong because again, the load is applied over area.

So if you have a very small area, you have the potential for very high pressure. It’s very much like the high heel, the lady’s stiletto heel, right? She steps on that, on your foot with that, it’s gonna hurt you. But if she was wearing a flat sandal and would leave a big imprint, it wouldn’t hurt you as much. So the T-scan data allows you to choose wisely what to adjust.

[Jaz]
And so, I mean, I think to make it really tangible for dentists is like prosthetics, right? When we are working prosthetics to help our materials, that if you’ve done like multiple crowns, or even nowadays very on vogue is treating wear cases interceptively with composite, and you do a full-arch or majority-arch composite restorations and you check with arctic paper and you see ink everywhere and you think, okay, I have good distribution.

But without the pressure data, you know, when you start using, you might see that, oh, 38% of the force is going down one molar. And then the other molars are hardly doing any work. So without that data, you don’t know to lighten it. And the other scenario we talked about last night was the patient that says, you know, I had this work done or whatever, and then these three teeth on the left side, they just feel really proud.

And every dentist who has kind of attempted to lighten the occlusion on it, and then still the patient says it’s proud. And then you told me that, okay, when you checked, and this was in front of everyone, you checked it whilst the forces were low on those teeth, it was the timing. They were the first teeth to touch.

And it was very subtle. They rise first and then everything comes. And when you adjusted those exact points, led by this data, so not just pressures, timing here obviously we’re talking about, then the patient was able to say, oh wow, now I feel comfortable. And that was a real amazing moment, which I’ve experienced myself.

I’ve been using it for a few years, including on some dentists. So shout out to Nikhil Kanani who came to my practice and he wanted me to take it. He was interested in T-scan, so I had a look and I made some minor adjustments and he bit together. Not only did it sound better, which I liked, to listen to the bites as well, but then he actually felt like, whoa, wow, that feels so much more comfortable.

[Robert]
Yes. Yes, no question about that.

[Jaz]
There’s no occlusogram that will give you that. Well, as we sort of, we’re about to get to the practice now and start a day of training with you, my last request is any sort of nuances that you want dentists to consider when they’re planning their next case or checking the occlusion and considering about, thinking about technology, digital occlusion, and actually implementing kind of this T-scan technology.

Like we discussed yesterday, the adoption of T-scan, whilst it has gone worldwide, to the level that dentists invest in loupes, the level that they invest in intraoral scanners, the level that they invest in so many more bits of equipment, yes, there is a cost to it, but when you look at some of the costs of the other things that we widely purchase, so I don’t accept that it’s the cost barrier because we’re also buying, you know, $80,000 CBCT machines.

We’re buying $50,000 intraoral scanners. Why is it that this, 10, $12,000, whatever it is, a T-scan. So I’m not, I don’t think it’s just financial. What do you think’s going on in terms of why are dentists not understanding the benefits of seeing objective data?

Like I told you something yesterday, which I say all the time to colleagues who ask me about T-scan, is I felt uncomfortable adjusting teeth without having data, just medico-legally. If I can see that the bite is way off, even in a prosthetic case, or any type of case, and I can do some adjustments to really measurably timing and pressure improve the occlusion, I feel so much safer. But I dunno why that doesn’t translate to worldwide. But obviously you might have a perception or an insight into this.

[Robert]
Well, the biggest resistance to the T-scan is political. It’s that the T-scan has disproved every occlusal theory. You don’t need to TENS anyone, you don’t need to neuromuscular treat them.

You don’t need to put people in CR. CR is a very compromised position that constricts the airway and definitely is not a physiologic position. Putting people there is unnecessary for most dental treatments. And so just by disproving all of these basic principles that people really believe in, no one wants to face that. And the most important one is the carbon paper paradigm, right?

T-scan has absolutely disproved the carbon paper paradigm. The big marks aren’t always big force. The little marks always aren’t light force. And making the marks look a certain way doesn’t give you a balanced bite. So there’s a lot of things that dentists have been holding onto politically because they’re teaching these things in continuums and–

[Jaz]
Can I talk about that? Because it’s something that in my teaching, so I’m involved in teaching occlusion, and so feel free to disagree with me, Rob, I take it, I’m happy to talk about these things, right, is what I teach is centric relation is a position of restorative convenience. It is a utility position.

So whilst my patients whose occlusion is generally working for them, I don’t, I work within the MIP. But when we have the opportunity or need to open the vertical dimension, it may be a position of reproducibility and convenience, then I’ll look to use it. ‘Cause when we have lost all references and that’s how me and Mahmoud have been teaching it. What do you think about that?

[Robert]
Well, the value of finding a reproducible position helps greatly in doing restorative dentistry. I’m a prosthodontist, so I worked a fair amount in centric relation where indicated. But I also found that I could open the bite in MIP and treat the person directly.

[Jaz]
Didier Dietschi does that. My old principal, Dave Winkler, used to work with, he is now, maybe you know him. Do you know Dave?

[Robert]
I’ve heard the name.

[Jaz]
Yeah, so he used to practice here in Windsor. He’s now gone retired in Denmark. Wishing you well, Dave. Hope you’re well, buddy. And so lots of dentists I really respect, you know what, they work in MIP and even when the vertical, like obviously when you open the vertical dimension, MIP is gone. But like what you’re trying to say is like, you’re not really seeking the CR, you just open the bite arbitrarily.

And then just trying to create the correct occlusal scheme led by the T-scan in that arbitrary position. And that works well, has worked well for many dentists.

[Robert]
It works extremely well, actually. And you can mount the casts and then raise the articulating pin and mount them in MIP and raise the articulating pin, and then work in that new vertical dimension, essentially the same way you would in centric relation. So it’s very possible to do. It’s not, let’s say, academically principled that you shouldn’t do it, right, but it’s a reality.

[Jaz]
A hundred percent.

[Robert]
And so there is a lack of need for concepts about jaw position being the key to success. You can put someone in CR, but if their micro occlusion isn’t well managed, they’re not gonna be comfortable. It’s not about the position. No jaw position manages the micro occlusion.

It’s the micro occlusion that brings about patient health, accurate, not accurate, but physiologic muscle physiology, as opposed to excessive muscle physiology and occlusal comfort for the patient. It’s all about the micro occlusion. That’s why you take a beautiful outcome like Invisalign.

The teeth line up beautifully and the patient comes in and says they’re not comfortable. It’s because the micro occlusion isn’t good. The macro occlusion doesn’t make the micro occlusion, and that’s where the T-scan is the huge advantage for finalising cases. That’s the most important thing I would say that the average dentist struggles with is extra visits after delivery.

The biggest problem is a patient coming back complaining, saying their bite isn’t right, and then randomly grinding. The T-scan virtually eliminates that. It doesn’t eliminate it in total. Nothing eliminates it in total. But you send the patient out the door with a high quality micro occlusion, there’s a lot less for them to complain about.

[Jaz]
And also less stress on the materials, ’cause if we’re working with prosthetic materials. Going back to prosthetics now, I’ve had these scenarios whereby, over time in the last few years of using T-scan, patients like, well, some of them, many of them actually, are very accurate. Before the T-scan data comes through, they can tell me that something over here.

Now when I check with the arctic paper, everything looks okay. But when I show the T-scan, I can see the early rise or the high point. And they often, for these patients who are very “princess and the pea,” which is amazing. So it’s very validating to them. And the trust aspect is there, but also the flip scenario.

Well, the patient says, yes, it feels proud, but I’m going, I’m checking the T-scan and reproducibly, I’m seeing that there’s no timing issue. There’s no pressure issue. Then I feel okay to say, ah, let it settle, kind of thing. You’ll get used to it, or whatever it could be. And then rather than praying and wishing that, oh, hope it’s not proud, and let’s see. So it gives me that again, objectivity, which is why, the reason why I went into–

[Robert]
Extremely objective and highly repetitive. A user has to learn how to use it. It doesn’t work by itself. You can’t buy it and make it work. You have to take training like you’re about to go through. And didactic training is helpful, but it doesn’t make someone a chairside effective T-scan user. You have to be–

[Jaz]
It’s a bit like, when you go into implants and you buy implants to use in your patients, there’s a lot of training that comes with implants to be able to do it, right? Same with when you pick an aligner system and you go with them and you go on the two-day course to learn to use the technology.

So, fair enough, when I got the T-scan installed, it was like being given an aligner system. But until you learn ortho and diagnosis and actually treatment planning in ortho, and then troubleshooting and retention or everything that goes with the education of orthodontics. So that’s a good analogy to think that, okay, the T-scan is like the aligner system. It’s like the implant, but you need to have the protocols in place to be able to actually get the best results from it.

[Robert]
And you need to have clinical experience under guidance. It’s not something you can pick up on your own. And this is why people struggle with it. They purchase it. They don’t seek out the training that you’re about to have.

That’s what makes someone a chairside effective user. It’s not possible to become chairside effective because you read a book or you read a paper that I wrote about, for example, the disclusion time. Even though it’s well described what to do, it doesn’t make you a clinician. It’s like reading about a crown prep.

You can read about a crown prep, but until you’ve cut 50 crown preps, you don’t have the skills to cut predictable crown preps, right? So T-scan is a chairside learning technology that once you understand what to do with it, how to record, how to read the information, how to understand the force versus time graph, which is a critical software feature, and how to apply the information to make intelligent decisions about what to treat, then you can become effective with it.

But you have to learn those three things. Recording well, understanding how to read the data, what matters in the movies, what doesn’t matter, what parts of the movies matter, what parts don’t matter, and then how to apply the information by mapping the pressures using carbon paper.

But you don’t look at the carbon paper and say, yeah, it’s that one because it’s big, or that one’s too small, we’re not gonna treat that. It’s all data driven. That’s the difference. By doing that you control the micro occlusion and get much more predictable outcomes.

[Jaz]
Well, excited to walk into the practice now and let’s get into the micro occlusion of it. Well, thank you so much. Alright guys, I hope you’ve got some insight there into the nuances of occlusogram and why that is to be taken with a massive bag of salt, and also a little bit more about the details of micro occlusion, what T-scan does. Uh, and yet wish me luck on my training today. Be kind to me, Robert.

[Robert]
Yes, of course.

Jaz’s Outro:
Well, there we have it guys. Thank you so much for listening all the way to the end. A few different themes touched here from joint positions to muscular harmony, and of course the main event, which was all about the occlusogram. And now I hope you’re convinced that it’s lying to us, which doesn’t mean it can’t be useful to us.

We can still use that information. Just don’t think it’s giving you something that it isn’t. We are a PACE-approved education provider. You need to be either on the Podcast CE Plan or the Ultimate Plan of Protrusive Guidance. If you’re on the Ultimate Plan, you get access to all the masterclasses, including the recently added Splint Course, everything occlusal appliances, and the 21 Day Photography Challenge.

Head over to protrusive.co.uk/ultimate if you’re interested in that. Even just to join the community for free, we need to verify that you’re a dentist first, by the way, and we will do that. It’s very important to us that it’s a safe community, we do not want any members of the public on our special forum, so we do have a verification procedure. But if you head over to Protrusive app and request access to Community Plan, we will get you in.

So you can see all the good stuff that we have in the chat and the main feed and all these podcasts are on there. And some bonus ones that are not on YouTube or Spotify. Watch this space for that DTR episode that I promised you. And as ever, I want to thank Team Protrusive who do a wonderful job behind the scenes to get these episodes published and allow me to still practice dentistry, support the community, and serve my family, and essentially be a dad.

So thanks again, and thank you, the listener, watcher, once again for watching all the way to the end. I’ll catch you same time, same place next week. Bye for now.

Is social media killing professionalism in dentistry?

Are young dentists really “clowns” online—or is lightheartedness perfectly fine?

Is social media a disease? Where’s the line between humor, banter, and outright disrespect?

In this episode, Jaz is joined by Joseph Lucido from the States to tackle these tough questions head-on. Sparked by a fiery Facebook rant, they dive into whether social media is harming our profession, how dentists should present themselves online, and if there’s still room for fun without crossing the line.

Whether you love or hate dental content on social media, this conversation will make you rethink how we represent our profession to the world.

Shout-out to two US doctors creating excellent, entertaining content on social media

Check out the 3-Step Modern Dental Marketing Plan from Clear to Launch Dental — designed to help you simplify your marketing and grow your practice without the overwhelm.

Need to Read it? Check out the Full Episode Transcript below!

Takeaways

Highlights of this episode:

Love this episode? Don’t miss Best Practices in Social Media for Dentists – How to Stay Out of Trouble Yet Be Impactful (IC035)

#InterferenceCast #Communication #BreadandButterDentistry

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 walkthroughs and Masterclasses.

Teaser: What is the correct etiquette in 2025 and beyond for social media for dentists?

Teaser:
The biggest shortcut a lot of social media questions get would be, we tell a lot of docs, this is social media, it’s social in nature, so your job is not to directly sell 24/7. The most extreme version of yourself is gonna get the most attention. So you might get, oh, look, I’m getting a lot of views. But going back to what I said earlier, it’s, well, what are people thinking when they see this?

Jaz’s Introduction:
I saw a rant on Facebook. Obviously it was on Facebook. Where else do rants belong, right? It was saying, what has happened to our profession? What has happened to our beloved dentistry? The kind of crap we’re seeing on social media.

This dentist, who’s basically vexing about the way that he thinks young dentists are portraying themselves on social media, this anonymous poster of course, was saying we’re being clowns, we are disrespecting patients, we’re doing all sorts of unsavory things to get views and likes.

So Protruserati, is this the death of professionalism in dentistry? Is social media a disease? Is there a proper way to conduct yourself on social media, or is a bit of humor and banter and a bit of lightheartedness acceptable?

I’m a bit of an idiot on social media sometimes, but I know someone who does know. Today we’ve got our guest, Joseph Lucido from the States, and I asked him all these tough questions. He knows a thing or two about social media. So in this episode, you’ll find out what is the proper way to conduct yourself and whether Joseph thinks there is a space for idiots like me.

Hello, Protruserati. I’m Jaz Gulati and welcome back to your favorite dental podcast. This is an interference cast. This is a nonclinical arm of the podcast. Hope you enjoy the main interview and I’ll catch you in the outro.

Main Episode:
Joseph Lucido, welcome to the Protrusive Dental Podcast. For those who are listening right now, Joseph has sat in this wonderful, you’ve got this wonderful background, that common look of the books behind you, so it makes you look like you’ve got so much authority. And he totally looks badass. But I had to ask him, is this real or is it fake? And actually he reached out, man, this is a very beautiful library behind you. Joseph, welcome to the show, my friend. How are you doing?

[Joseph]
I’m doing great. Happy to be here.

[Jaz]
Tell us about yourself. You’re not a dentist, but tell me how you are connected to dentistry. What makes you an authority? Talk about social media for dentists today, which I’m really excited to get into.

[Joseph]
Sure. Probably starting around eight years old, I wanted to be a dentist. Just being in the dental office, I always loved getting my teeth cleaned. I had a few uncles that were dentists. It was just exciting for me.

And then just through my education, formally marketing degree, and then half of the books behind you are on marketing or psychology. And then it comes down to just different reps over and over and over on different platforms with docs, seeing what works, seeing what doesn’t work. I guess that gives me, I don’t know about the authority, but it gives me a pretty sharp edge on what works and what doesn’t.

[Jaz]
Well, I think that does give you authority. The fact that they have skin in the game, the fact that you work with people on this, so you totally have the authority.

Interesting title we’ve opted for, right? Social media clown or healthcare professional. I really like this. When I first read it, I thought, oh crap, he’s onto me. He’s seen my videos. Because sometimes I’m a bit of a clown, and sometimes I’m very professional. I’m really looking for what your thoughts are on this.

So I guess the first place to start is, what is the correct etiquette in 2025 and beyond for social media for dentists? It’s a big topic and we can break it down and go anywhere you like.

[Joseph]
Yeah, there’s gonna be a bunch of nuance to it, but the biggest shortcut a lot of social media questions get would be, what is the potential patient, the person viewing this, the followers, what are they gonna think after seeing whatever I post?

That should just be your starting point for everything social media related. Before you post, you want to be intentional in thinking. Now it becomes intuitive after a while to do it the right way, second nature. But from an etiquette standpoint, we wanna be thinking, I don’t wanna post anything that’s too controversial or too polarizing.

Now I’m talking specifically through the lens of a healthcare professional. If you’re trying to get attention some other way, that’s fine. But if we’re talking about being a professional in healthcare, we don’t want to talk about politics or religion. Avoiding these topics can alienate 50% or more of your audience, and it also kind of speaks to your self-awareness. You probably shouldn’t be posting this from a business perspective.

Arguing online, never a good look. Taking a combative stance, anyone who sees that, even if you’re defending yourself, even if you’re 100% in the right, that’s not what you wanna do from an etiquette standpoint.

We tell a lot of docs, this is social media, it’s social in nature, so your job is not to directly sell 24/7. Everyone’s seen the doc that posts and all they’re doing is selling, and you’re not gonna follow them.

[Jaz]
So what you mean by that is, “Come in for our new patient Invisalign offer,” and just banging on about it every single day, and that’s it, it’s like repeat.

[Joseph]
Even the other post is too much. And what we’d even argue is, the way that we operate it is we have the docs say, you do nothing from an office level organically. You should be fun, entertaining, posting like that, and then we’ll take care of the direct selling, because that’s what our team has experience in.

You don’t have experience in, how do I sell something, specifically the language that needs to be used, the call to actions, where the buttons go. That is so outside of your purview. But what’s inside of you, you’re an expert on you and your office. That’s what you should be posting about.

[Jaz]
I think one thing that perhaps I should have asked, and I will now, is taking a step back. I think I went too deep too soon. I’m trying to understand what you are trying to say and what we can learn.

Like I said, building on that correct etiquette and top mistakes we make. Now we are at a stage where virtually every dental practice has a website, I would imagine. But not all dentists have a social media presence. But those that do, a significant majority of those would probably post on 4th of July and then post on Halloween and then completely abandon it.

So let’s tackle that for a second. Do we need a social media presence in this day and age to be a thriving clinic? Because in the past it was, word of mouth is the best and patients refer other patients of the similar kind of caliber and likeness, which works well for clinics. What do you think about that question of the need of social media for every practice?

[Joseph]
So I think practices still, word of mouth, referrals, those are the best practices. Practices where it’s in the front door, out the back door, they’re always gonna be chasing the new patients.

But when it comes to social media, the effort that is required for the return on that investment, if it’s posting once a month, having someone in your office just post strategically once a month. Because what people are really doing nowadays is they’re just checking to see if you have a pulse.

Yes, we can get information from your website, but if you have an Instagram account or a Facebook account, you can do the bare minimum. What people are doing is verifying, and it also gives the opportunity to see what it looks like inside of the practice, who works there, what other patients are saying.

That’s so important because in a day when people are buying, they’re gonna be looking at multiple different dentists. Even if from a word of mouth standpoint they recommend you and someone searches the internet, social media has an effect where you show up on the internet. Some of your social media accounts will show up.

By checking that box at a reasonably high level, with minimal effort, it verifies that, hey, I’m a professional. It gives you an opportunity to make a great first impression outside of your website.

[Jaz]
I’m aware that, myself included, I had to pick a surgeon for my shoulder. Patients will Google their practitioner, or they’re thinking in their town, they want to get teeth straightening or just find a family dentist. As well as asking friends and colleagues and their new workplace, they will Google, “Who’s best? Name me,” or they might get a hunch about this clinician, “I’ve heard good things about them, let me now Google their name.”

Do you think the behavior has now changed so that the “younger folk” are, instead of going to Google, actually searching on Instagram or searching on TikTok? What are your insights showing based on how important presence is, relative to the website presence and what shows on Google?

[Joseph]
Yeah, we don’t have to guess. The numbers are showing the search volume going up. I think it’s a very well-known fact that YouTube is the second biggest search engine in the world.

But then after that, you’re gonna be seeing Instagram, Facebook. People are checking those boxes and looking. Just by having consistency across all of those, you are gonna have the opportunity to put your best foot forward again. So we don’t even have to guess. That is 100% happening.

We’ll say younger folk, but younger, I’m starting to date, I’m getting a little old myself. So younger folk being 50 and under is completely applicable in this situation.

[Jaz]
When it comes to social media, one advice that I took onboard is trying not to be great on all the platforms. Pick one platform at a time and try and make a presence and work on your goal there before you then go elsewhere.

Because then what you have is this dead X profile that you never post on, but it just exists and it doesn’t reflect well on you or your clinic. You might as well not have it. Is that what you think as well?

[Joseph]
I like to have everyone run it through someone else’s perspective. If I see an account, X, Facebook, Instagram, and they haven’t posted in eight months, what are your thoughts?

“Oh, they can’t keep up with this. Is this place no longer open?” It puts a seed of doubt that could be completely removed if you didn’t even have it or if you kept up with it.

That’s exactly right. I encourage docs, let’s do the main ones. Let’s do Facebook and Instagram. Once we’ve proven that we’ve got a great system in place, and by system I mean someone at the office level putting out great content consistently on those, then you can explore into others. But those are gonna be the main ones that you want to hit.

[Jaz]
Compared to website, if website has extremely high importance, it’s where you have your testimonials, your contact details, the first place that potential patients see. Is Instagram or a named social media platform the first place that you want to perhaps name drop? How important is it relative to the website presence?

[Joseph]
People are gonna go different places for different things. Instagram, they’re gonna be looking extremely visual at what they want. On a website, you have the opportunity to highlight exactly what someone is looking for.

So if we think of someone who’s doing this great, Dr. Brian Harris out of, I think it’s Phoenix, he is highlighting exactly what the patient experience looks like. Then you also have high profile celebrities who have just gotten their teeth done. He does an unbelievable job of painting a picture for you, and you say, oh, I can go to that office, I know what it’s like, there’s the front desk person.

That is more what the website is for, information and guiding people through, “Here’s what it’s gonna be like to be a patient here.” Instagram, TikTok, Facebook, you have an option to entertain and show more of your personality there. Just humanizing yourself is a good way to think about it.

They all serve different purposes, but at the end of the day, we wanna paint you as a doc in the best light possible.

[Jaz]
What if you like to be, I mean, yes, I agree. Religion and politics, that kind of stuff, are perhaps more appropriate on your personal profile, not on your business profile.

But I see some hilarious, there’s two really funny US docs. I’ll find their name and I’ll put them in the description. They make really funny content that’s perhaps borderline not appropriate, what dentists talk about, but they do it in a very nice way. They do it not in a disgusting way. It’s good humor and I love it.

I love what they do. I don’t know if patients resonate with that, but in terms of, as a dentist looking at it, it’s real talk. It’s hilarious. Is there a place for being funny and being a clown on social media because that could be a true representation of yourself and your values and who you want to attract? Or do you feel that, again, that’s something that belongs on your personal profile?

I’m sure you can think of some very successful social media accounts of dentists, doctors who are putting out very funny scenarios. There’s one where the guy’s blind. He’s a dentist, he’s blind, he’s walking in the clinic, and the patient’s like, “Wait, what the hell’s going on?” And it’s like, “Well, you are the one who said you don’t want any X-rays, right?”

So you’re doing the whole thing blind, and as a dentist I resonated so much with that. But that’s also being seen by the members of public.

[Joseph]
Right. I think the idea of entertainment is a loaded word, and there’s a lot of different ways to be entertaining. That’s a very clever way to be like, “Oh, you don’t want X-rays,” but they’re giving the analogy of what it would be like to operate without them.

It’s gonna resonate with more docs than it will with patients, but at the same time it’s gonna hit a lot of patients. And I think you hit the nail.

[Jaz]
It might then get rid of some patients who say, “I don’t believe in X-rays, I’m not gonna go ahead,” and you know what? That’s a win for the dentist and that’s a win for the patient.

[Joseph]
Yeah, and I think that’s kind of your personality. If you are funny, if you are witty, then yes, being in line doing that.

This is where that line, and there’s always gonna be edge cases of someone who does have a big personality and that being entertaining is what they’re gonna do. But entertaining being a loaded word, most people hear entertaining and they think shocking, in-your-face comedy.

The reality of the situation is you can be educational, you can be interesting, novel, it can be heartwarming. You could do storytelling, visual. There’s a lot of ways to be entertaining. Planet Earth is a great example of this. It’s not funny at all. It’s very entertaining. It’s very educational. It’s very visual.

Completely different than someone who gets a lot of attention. Think of Britney Spears. She got a ton of attention from melting down. Yes, she got a ton of views. That’s not what you’re looking for, so that’s not great.

I tell people all the time, the most extreme version of yourself is gonna get the most attention. So you might get, oh look, I’m getting a lot of views. But going back to what I said earlier, what are people thinking when they see this?

If you are a clown on social media and you’re dancing and that’s not your personality, or you’re making some jokes that are a little bit too far, then that’s gonna deter people.

The problem is, you’re never gonna know that you didn’t get them. Because when you deter people, it’s not like they call and say, “I’m not doing business with you.” They just go somewhere else. So operating on that line of entertainment without being extreme is the fine line that you don’t want to cross.

[Jaz]
I think it boils down to what kind of frame you wanna put on yourself. I use that word intentionally because of something that one of my mentors, Dr. Michael Melkers, taught me. He was presenting in London. He said something really interesting.

He said he doesn’t actually connect with patients in terms of knowing the name of their dog and family and that kind of stuff. The frame he puts on is highly professional. “I’m here to listen to you and diagnose and help in co-diagnosis and helping you.”

Whereas I’m very much like, “Hey, how’s your daughter’s football game going?” So I pick my frame. I like to be the friendly neighborhood dentist kind of frame.

When he mentioned that, I thought, that’s true. The kind of clientele he attracts and the kind of plans he might be doing will be fitting to that kind of professional frame. Some patients will resonate and enjoy that more. Whereas some patients will be very put off by this friendly dentist and they’re actually looking for someone who’s more of a surgeon than the friendly dentist.

So I guess the answer, there’s no right or wrong answer. I think, Joseph, the worst thing you could do is not choose which frame you’re going for.

[Joseph]
Correct. And I would say there is a right or wrong because you hit the nail on the head. You speak jovially, you’re talking about sports teams and these different things. When people come in there, that’s what they’re gonna expect, and then you don’t have to change personalities in the office.

I do like the very professional, very straightforward medical professional who is going to help me with anything that I have going on with my teeth, no nonsense, down to business. So when I’m looking at docs on the internet, I want their content to be about that. You are an expert and you’re no nonsense, and that’s gonna attract patients like me.

At the end of the day, you wanna attract patients that you enjoy working with. There’s nothing worse than attracting a bunch of patients that are looking for a different experience, and there’s this subtle disconnect. When that disconnect happens, that’s when you see patients leaving because you don’t have a great relationship with the doc.

It’s almost like a mini bait and switch. Docs are like, “Well, I don’t understand, they came in.” It’s like, well, you’re behaving differently online than you are in the practice, and it creates this disconnect that you’re not looking for.

[Jaz]
Reminds me of something. There was an Australian, I think it was an Australian dentist. His name was Paddi Lund. I think he maybe still operates, but he used to, in the early noughties, teach and do courses about that generation of marketing.

I think he wrote this book about dentists, kind of like firing your patients in a way that you eventually kick out the patients that don’t share the same values as you, and eventually you become a liberated and happier professional.

One thing he teaches is, if you are passionate about football or soccer, have the jersey of the team hung up there. You’re putting it out there that these are the kind of patients you want. Eventually with time and experience, your list of patients ends up reflecting you. I like to think of it like that.

I think what you said there is you just have to decide what kind of person you’re going for and be authentic. It’s all about being authentic and not doing something for the sake of social media, and then patients coming in and saying, “Wait, hang on a minute, this was a different person on social media.”

But if you are presenting the same way on social media, you know what you’re gonna get. As long as it aligns with your values, then that will lead to a happier practitioner and actually more fulfillment from their work.

[Joseph]
Yeah. When you say it like that, it sounds so easy. Just be yourself and you’re gonna attract the people that are coming in there. We call it humanizing yourself.

A great way to think about it is, for example, if you’re a dentist and you like to golf, every now and then posting about golf, that’s 100% acceptable, because then other people see, “Oh, my dentist is a golfer. Hey, I’m a golfer, I like this.”

You go into his office and maybe he’s got some places he’s been. That’s cool. Now, if you post every week about golfing, then the patient thinks all this guy does is golf. He probably knows more about golfing than dentistry. He doesn’t want to be here, he just wants to be golfing.

You do have to think of it through that. But you do want your personality to come out through your social media. Like you mentioned, sports are one of the big ones. If you are a diehard, who’s your soccer team over there?

[Jaz]
Manchester United. We’ve had very bad, dead seasons unfortunately. I’m gonna have to cut that bit out of the podcast, it’s that bad of a season we had. Anyway, I’m just kidding.

[Joseph]
Oh no. Historically one of the worst ones we’ve ever seen. Big soccer fan. But if you put that out there, other people are going to resonate with that. Guess what? Eventually you have an office filled with Manchester United fans.

Even if you get some Chelsea or Liverpool fans in there, there’s some banter going back and forth. There’s some conversational things.

One big thing is we let docs know, on social media you should be shopping or supporting local when you can, letting people know that. Because let’s say you go to a restaurant that’s right down the street from your office and then you post about it. Well, guess what? Everyone that goes there, they tag you. They have a bunch of people that are gonna come there too. Then you’re in the community as well.

So there’s a lot of opportunities to be authentic, which is, I think, an overused word in social media. But just be yourself and highlight the things where possible, and you’re gonna get people that really enjoy coming to your practice.

[Jaz]
You mentioned about not oversharing the whole personal side. I guess it goes without saying that if you want to do the personal stuff on Instagram, have your own personal account and have a separate account for work.

Although some people I’ve seen just combine it. They post about their kids and then, “Oh, here’s a smile makeover I did the other day.”

What is your stance and advice to dentists who are thinking about, should I have two accounts, or should I just have one and just, that’s the whole package, you get me, you get the whole package?

[Joseph]
My advice is two separate accounts. One needs to be business related, and you don’t wanna be posting your kids and make it a private account.

If someone is a patient and they become, I’ve been in many doctors’ weddings, I’ve become friends with a lot of these docs. There are so many great people in the industry. They follow me on my personal account, and then we also have a business account.

What I’m putting out personally shouldn’t be shared with everyone that comes to my practice. So yes, I would say having two different accounts is what I would recommend.

[Jaz]
Fine. That’s a very clear recommendation. I agree with you.

Another thing that’s crossed my mind is with social media, the algorithms and the way it all works so that you have potential to make a good piece of content and it can be seen. One of my reels has over a million views. It’s great, like, wow, this is cool.

Now, when clinicians are trying to appeal and raise awareness to patients and attract a certain type of patient, for example, and they do a piece of content that blows up, but actually when you talk about how many inquiries did this lead to, one or zero, because it’s going to the world.

If your practice is in Phoenix, Arizona, and someone in Jakarta in Indonesia is seeing this and they’re laughing and they like it and share it to their friends, it’s not really benefited you.

So what is the strategy that you advise dentists to do? Because their main goal is not necessarily to entertain, and you can’t deposit likes into the bank. You’ve got to actually be able to be relevant for your local community and solve problems for your local community. How does that change the way that you play the game of social media?

[Joseph]
I’m gonna steal that, “You can’t deposit likes in your bank account,” because I’ve never heard that and that’s a good one.

What I’ll say is there’s nothing wrong with that, but what is your expectation and how did you get it? Did you go viral because you put something so outrageous out there?

But let’s say you put out something that was great, clever, whatever it was, and it went viral. There’s gonna be value to that because if a million people are seeing it all over the world, that means the number of people seeing it in your local area is also gonna be high. That’s just how we think about it. Content’s great content.

When it comes to the algorithm, highly debated topic. The shortcut for thinking on how the algorithm works: what am I gonna do that is rewarded by the platform?

Google’s first algorithm was basically how many websites you were linked to. Now they have hundreds of things that go into that.

What is social media rewarding at this time? It’s always gonna be changing, but if you can look around at other people’s content that’s doing well, that’s a clear indication that’s what that particular platform is rewarding at this time.

[Jaz]
Fine. That helps. As long as there’s good content, it’s good content, and it can only help you.

But when you are talking to your clients and dentists about making a difference and actually making, what kind of content do you tell dentists to make? They’re looking to you for advice.

Should we just make, “How to brush your teeth better”? “We are doing a fall promotion,” or, “Do you like the fall promotion?” What kind of content is good?

We’ll segue from that into the dos and don’ts as a final segment of this podcast. But someone’s listened to this and thought, you know what, Jaz and Joseph are right. I need to have an Instagram presence. Let me reactivate. Let me make one for my clinic. Let me make one for me as an associate or a practice owner and talk about my work. I’m passionate about it, but then they’re like, I don’t know what to talk about. I need some ideas.

Nowadays with ChatGPT and stuff, you just need to give the right prompts, you’ll get the ideas. That still needs an expert touch and experienced touch. So with that in mind, what kind of content should colleagues be making?

[Joseph]
There’s so much nuance to this question. I will try and be brief.

Highlighting your strengths. Thinking about the content that you’re putting out. Whatever type of dentist you are, even if you’re a general dentist, why are you good?

Highlighting your professionalism. Highlighting patients, because there’s always gonna be this ratio. You don’t want to always highlight patients, you don’t want to always highlight staff. You want to have this blend of it.

You want to paint a picture of what it’s like, a day in the life. It’s almost like a mini reality TV show of what your social media looks like. “Oh, I can see these patients. I can see new equipment,” whatever it is.

We just want to make sure that it’s your personality being super important and the personality of your office. So you’re saying, “What do I need to post?” I think it’s more, what is the blend that I need to post?

Letting people know, these are the type of patients that are here. This is the type of staff that’s here. This is what I’m like personally. This is what I’m like professionally.

Then you have just the general throughout the year, like, oh, it is Halloween, it is Christmas, and you can mix those things in. You’ll never be short on content.

We have a completely free social media calendar that we put out every single month because it’s just, here’s what you could post every single day of the week, and it’s content ideas. The amount of content that you could post is really unlimited.

[Jaz]
So we’ve covered there what we could post and there’s so much out there. But the number one thing I hear from colleagues, especially those who are maybe a little bit older, is, how do you find the time?

That’s probably the biggest objection: time. So what’s your advice to colleagues who think, where do you find the time?

[Joseph]
Where do you find the time? This is something that depends on the person. If the person’s on social media and they’re posting on their personal, we can carve out that time pretty easily.

But for docs who are not consistently on it or posting, one of the easiest things in the world, because every doc is busy, we know that. They need to be running a business, production, that is the most important.

This is something that we typically offload to front desk staff. You can work with them. You do not have to pay them much to do this because it’s so native to someone who is younger.

You can also have content days where once a month or once a quarter, you’re gonna get these 20 different pieces of content. That way it’s not an everyday grind.

We have some practices that twice a year, two times a year, have a photographer and videographer come in, and you can even do this with just an iPhone. They’ll have a list of, “We are gonna get these 20 photos,” and that is gonna be our posts for the next six months.

When it’s, “Can I do content two times a year?” Then the lift seems a lot less heavy versus, “What am I gonna post every three days?” That can be exhausting.

So it’s more, we know what to post, now if you’re talking about the tactical, how do we do it, just batch it. If it’s not your thing, outsource it to someone on your team and then batch it a couple of times a year, and you’re still gonna get the outcome.

[Jaz]
I think a lot of people fall into the trap of they know it’s a good idea, they know they should be doing it, but they don’t have that delegation conversation or some basic training, or imparting the values of what we want to do, and then letting someone on the team and trusting someone on the team to just go for it, then revise it, and have some sort of intention or being proactive about it.

So it’s good that we’re talking about this. Let’s then talk about dos and don’ts. Let’s say Joseph’s dos and don’ts when it comes to having a presence as a dentist on social media.

[Joseph]
I’m such a stickler on, when I see content, it’s impossible for me not to view it from every different angle. So we wanna start with the very basic ones first.

Make sure your environment’s clean. Don’t ever show a dirty break room. I can’t tell you how many times I’m like, oh, it’s someone’s birthday, and there’s food wrappers in the background. When I see that, I don’t need to be seeing the back of the house like that, and a patient doesn’t either, because you don’t know how they’re gonna judge you.

So just making sure everything’s clean. That’s a big do and don’t, making sure everything is in order and it looks great.

[Jaz]
It’s like a risk assessment. When you’re in a practice, you have to risk assess every little thing. Before you hit record, it’s kind of like a risk assessment you have to do.

What could someone think about this? What could someone think about that? Setting the scene before you press that record button.

[Joseph]
That’s exactly right. If someone’s new, their only impression of your business, they’re gonna analyze that too. They might not externalize it like we do.

It’s like, well, if they can’t even take care of a clean break room, do they have clean ops? Are they good hygiene? Do I really wanna go here?

All of that goes through their mind in two seconds and they don’t even realize it. They just know, maybe this isn’t the dentist for me.

So step one, make sure everything is clean, organized, highly professional, especially for any photos that you’re gonna be posting.

Then dos and don’ts, it’s a lot of the things that we covered. Not selling, not acting crazy, versus running it through the filter of, how are people going to view me in this situation? Once they see this post, are they more or less likely to go on the internet and make an appointment or call me? That’s a very easy heuristic to run through.

[Jaz]
What’s the number one thing a clinic could do to help see results from their social media? If their aim is, we’d like to see more new patients every month to keep a healthy flow of patients and be able to do the kind of work that we’ve trained to do, and we wanna make sure all our associates are full of patients, what’s the number one Pareto principle?

The 20% things that you do that make 80% of the difference. What are the Pareto principles of social media to actually get bums on seats?

[Joseph]
I think it is very easy. You want to be posting content about satisfied patients.

One of the easiest things for us to think about: if we’re working with, say, a peds practice and we know the household decision maker the majority of the time is going to be a female from ages 25 to 50, and they’ve got two or three kids, the more content we can post about them being satisfied.

There’s a saying in business: how many satisfied reviews would you need to see to be convinced that I do a good job? Even in our business, when we engage with clients, it’s like, here’s a list, a wall of a hundred testimonials, and if you don’t believe any, reach out to any of them if you want.

No one’s ever really reaching out to a lot of these people, but if you think about it at a practice level, if all they see on their social media is happy patients like them, that’s the number one thing. The shortcut is, they clearly know what they’re doing with people just like me and they’re happy. I would also be happy.

So that’s the number, that’s the Pareto principle of what do I need to be posting to get bums in seats, as you so eloquently put it.

[Jaz]
I think it makes so much sense. Social proof, it’s always about that.

[Joseph]
Yeah.

[Jaz]
I love this little overview of social media. Joseph, how can we learn more from you? How can we follow you? How can we see what you get up to, my friend?

[Joseph]
I’m just here putting the good word out. I did mention the social media calendar, which is apt for this episode. It’s something that we put out every single month for free, and it just goes to offices and gives them ideas, inspiration, makes it easier for them. It’s not cookie cutter, it is a framework, and then you put your customization into it.

The other biggest thing is, I think it’s been viewed a couple thousand times in the last month, we have a free, everything-you-need-to-know-about marketing plan. It’s the biggest CE that we get paid to teach. It’s everything that you’d ever wanna know about marketing, including social media, how to pick a provider, marketing theory, and how we got to where we’re at today in 2025 in the marketing landscape. So yeah, that’s it.

[Jaz]
Amazing. If you send me that, I’ll put the link in the show notes.

[Joseph]
Sounds great.

[Jaz]
Amazing. Well, thanks for the time and helping us to understand the value of social media, but also the etiquette and, I guess, whether someone decides they still wanna be a clown or not, as long as they feel it’s right, it’s in line with their values, speaking correctly, but also not in a way that’s gonna make people think, what on earth is happening in this clinic, and not causing adverse effects without proper risk assessment, which we delved quite deep into.

As long as everything is authentic and purposeful and someone’s put some thought in. It’s like when you’re going out, it’s nice for someone to say that whatever they’re wearing, they’ve put a little bit of thought behind it.

I’m the worst person at clothing myself and stuff, but my wife says, look, at least a minimum, someone should say, okay, at least he thought about it a little bit. It’s the way you dress. Your social media should be the same.

So Joseph, thanks so much for driving that home, my friend.

[Joseph]
Oh, thank you.

Jaz’s Outro:
Amazing. Well, there we have it, guys. Thank you so much for listening all the way to the end. About 99% of our episodes are eligible for CPD. This one isn’t. But I hope you gained value. I hope you get an idea of how to conduct yourself in social media or it inspired you to behave in a certain way or implement some strategies that we discussed today.

Please do not forget to hit that subscribe button. It really means a lot. I just want to take a moment to also thank Team Protrusive for all their hard work. I’ll put all the show links so you can reach out to Joseph below and for all of the nicest and geekiest dentists in the world in Protrusive Guidance.

Thanks for making a lovely community. And if you’re not already in this community, check out Protrusive app to join us. Protruserati, I’ll catch you same time, same place next week. Bye for now.

Cracked teeth — the diagnosis we all hate as Dentists!

How do you decide when to monitor and when to intervene?

What is the recommended intervention at different scenarios of cracks?

Should we be chasing cracks and reinforcing with fibers; is there actually enough long-term data to support that approach?

Over the years, we’ve had some epic episodes on this topic — from Kreena Patel’s “I Hate Cracked Teeth” (PDP028) to Dr. Lane Ochi’s Masterclass on Diagnosis and Management (PDP175).

But in this brand-new episode, Jaz is joined by Dr. Masoud Hassanzadeh to bring it all together — not just the diagnosis of cracks, but their management. They explore when to intervene, the role of fibers in preventing propagation, and even the fascinating possibility that cracks in teeth may have some ability to heal, just like bone!

This one’s a deep dive that will change how you talk to patients — and how you approach cracked teeth in your own practice.

 Protrusive Dental Pearl

Your patient’s history predicts the future!

History isn’t just background—it’s a clinical tool.

Need to Read it? Check out the Full Episode Transcript below!

Key Takeaways

Highlights of this episode:

As promised, here are the studies mentioned during the discussion:

Historical Studies on Enamel Crack Healing
– 1949 (Sognnaes): The Organic Elements of the Enamel: III. The Pattern of the Organic Framework in the Region of the Neonatal and other Incremental Lines of the Enamel

– 1994 (Hayashi): High Resolution Electron Microscopy of a Small Crack at the Superficial Layer of Enamel

– 2009 (S. Myoung): Morphology and fracture of enamel

Don’t miss out — get instant access to all the research papers discussed here at protrusive.co.uk/cracks!

Dr. Masoud Hassanzadeh has written two essential books every dentist should own:

📘 Glossary of Biomimetic Restorative Dentistry
🔑 Your quick-reference guide to the language and principles of biomimetics — explained in a way you can actually use chairside.

📕 The Cracked Tooth: A Comprehensive Guide to Cracked Teeth
🦷 Everything you need to know about diagnosis, management, and the science behind one of dentistry’s biggest headaches.

This Easter, join Dr. Jaz Gulati and Dr. Mahmoud Ibrahim for something truly special — a tax-efficient holiday that mixes world-class occlusion training with plenty of family time in Dubai.

🦷 What’s included?
 ⏰ 20 hours of hands-on occlusion (mornings only: 9 am–1 pm)
 🏖️ Afternoons & evenings free to enjoy Dubai with your family
 📚 Pre-learning + online content to deepen your understanding
 🥂 A not-for-profit event — just dentists, families, and fun!

👉 Learn more & get your quote at: globaldentalevents.co.uk

💡 Make memories with your loved ones while making your CPD hours tax-deductible

Want to level up your knowledge on cracked teeth? 🎧 Don’t miss PDP098: Cracked Teeth Management with the Direct Composite Splint Technique

#PDPMainEpisodes #EndoRestorative #BreadandButterDentistry

This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance. 

This episode meets GDC Outcomes A and C.

AGD Subject Code: 070 ENDODONTICS

Aim: To provide clinicians with practical, evidence-based guidance for diagnosing, monitoring, and restoring cracked teeth, with emphasis on prognosis, risk factors, and restorative decision-making.

Dentists will be able to –

Teaser: After 48 hours, they started to see that the crack is just decreasing, like it's just healing. Is it really possible? But it is possible. Like how there is a crack healing mechanism in the bone, there is also crack healing mechanism in the tooth. When I started to learn about cracks, actually the studies were not from dentists.

Teaser:
They were fracture mechanic engineering that they just studied about the crack, and nowadays there is a new system, it is called quantitative percussion diagnostic, QPD. There is a stress concentration in that point where the crack is started, so we have to distribute the stress in that place, in that plane. That is the important one. If we are just going to remove the crack and put the restoration on it, I’m afraid it’s just going to happen again.

Jaz’s Introduction:
Over the years, we’ve had some awesome episodes on cracked teeth. If you go all the way back to PDP028 with Krina Patel, the episode was titled, I Hate Cracked Teeth, and you know what? I still hate cracked teeth. They’re a damn nuisance. They’re everywhere, and it creates major consent and if the tooth goes non-vital, that kind of conversation, which no one likes.

Now, years later, we did this epic episode with Dr. Lane Ochi, PDP175. You need to check these two episodes out if you want to geek out on cracks. But you know what? This episode really does a wonderful summary of cracks. Not just the diagnosis, but the actual management. Should we be chasing cracks? Are fibers actually indicated? Is there enough long-term clinical data to support the use of fibers in crack propagation? And the question of, okay, when should you actually intervene?

And you know what? The most important one I haven’t even mentioned yet. So, Dr. Masoud, the way I got acquainted with him is on social media. I posted this image of a crack, a really nasty crack, and he said something absolutely ridiculous. He said that cracks have an ability to heal a bit like cracks heal in bone.

Now, you said that because in this image I posted on social media, it was all about how I communicate cracks to my patients. I say to them, look, when you have a crack in a bone, the bone can heal, it can regenerate, but a crack in a tooth can never heal. Patients seem to resonate and they understand that. But he was suggesting that actually cracks can heal naturally a bit like bone. And so if you listen to the end of the podcast, you will see how that is actually possible.

Hello, Protruserati. I’m Jaz Gulati and welcome back to your favorite dental podcast. I’ve had a month in August which was pretty crazy. I didn’t do much recording of new podcasts. We were working on some of the older recordings I had done. We’ve got a huge backlog as a team, which is a wonderful position to be. We are having so much fun creating these episodes. Thank you to everyone who returns to our podcast, and of course all the new people that find us.

If you’re not already, you need to join 5,000 of the nicest and geekiest dentists in the world on the Protrusive Guidance app. Go on protrusive.app, make an account. Your only requirement is you must be nice and you must be geeky. If you are those two things, you should come and join us to geek out, discuss, share challenges, share wins. It’s a nice wholesome environment we’ve created far, far, far away from the toxicity you get on Facebook.

Dental Pearl
Now in true PDP fashion, I’m gonna give you a Protrusive Dental Pearl. This pearl helps me when I’m decision-making with my patients, and it’s all about probing further into the history of the patient. What I mean by that is when we have that patient, and we’re planning an extraction, let’s say the tooth has had it, it needs to come out, and we’re trying to gauge, will this be a difficult extraction or not? Did you know asking them if their previous extractions were difficult is actually a useful indicator? An oral surgeon once taught me this, and I think it’s true.

People have certain features that make their teeth more difficult to remove, certain curves, certain densities of bone, and that’s a useful thing to have in your history. Now, similarly in cracked tooth management, it’s good to ask a patient how they lost their other teeth. So if you see a patient and they’ve lost some molars and premolars, you should ask, well, how did this happen? For what reason did you lose the teeth?

If they mention cracks as the reason why they lost those teeth, those other cracks which are asymptomatic, because 90% of cracks are asymptomatic, now you have a reason to be a bit more proactive and less of the wait-and-watch and more of the, well, let’s prevent this from happening to any other teeth. Those are two clear examples of how the patient’s history, i.e. the complexity of the extraction and the reason for tooth loss being cracks, are useful in decision-making for the patient going forward.

Now, I’m actually very excited to get to the main episode. Honestly, this is such a beautiful, geeky episode with real tangible clinical nuggets for you to take away. And before we start this episode, I just wanna give a quick plug to our trip in Dubai 2026. So Easter holidays 2026, we’ve got UK dentists and their families and some Aussie dentists who are gonna go to Dubai to learn occlusion with me and Mahmoud. Why are we doing this? It’s Easter holiday, it’s Easter vacation. I wanna take my kids and my wife. We want to have some family fun in Dubai, but we want it to be tax deductible.

So how are we doing that? Picture this for those of us with families and kids. Bring everyone along. We’re gonna make it a very tax efficient holiday for you. We’ll be learning occlusion from 9:00 AM to 1:00 PM for the five days. So that’s 20 hours of hands-on occlusion, and the rest of the day is self-study. Go to the pool, have some cocktails while you think about occlusion. Go enjoy the nightlife of Dubai while thinking about occlusion, of course. You get to enjoy most of the day with your family or with your friends in Dubai, and it’s just the morning part where we’ll do the education.

You also get access to a lot of online content and pre-learning, and we actually genuinely want you to come out having learned occlusion to a very high standard. But actually, I’ll be honest with you, this is about the education, but it’s also about having a good time in a tax deductible or tax efficient way.

So if that’s piqued your interest, I want you to go to globaldentalevents.co.uk. That’s globaldentalevents.co.uk. Like I said, you don’t have to be from the UK to come to this. We’ve got some interest in Scandinavia. We’ve got some bookings from the UK dentists and their families. We’ve got some Aussie dentists coming along, and we don’t need massive numbers here. 

We just need enough so we can put on a good show, but also we just need enough people to have some fun. This is actually a not-for-profit course. Me and Mahmoud are not doing this for profit. We just wanna have a jolly with our families and that’s straight from the heart.

I put the links in the show notes. You are gonna love this episode. Catch you in the outro.

Main Episode:
Dr. Masoud Hassanzadeh, welcome to the Protrusive Dental Podcast. You are speaking from the Netherlands right now. It’s so good to connect with you. Let me tell you and everyone how we ended up on here. I posted something about cracks on social media, and you said something so mind-blowing, so fascinating. I thought, I need to speak to this guy. Do you remember what you said? You mentioned—

[Masoud]
I know.

[Jaz]
You said we can heal cracks like bone. And so we’re gonna have to go there eventually because I’m really fascinated. Obviously there’s a bit of tongue in cheek there and whatnot, but I’d like to hear what’s the best thing we can do for cracks.

Many years ago, I did an episode with an endodontist, Krina, who’s wonderful. We talked about how much I hate cracks, because when you have a crack, there’s so many different ways it can go. The patient can become symptomatic. 

We need to have a lengthy consent discussion with the patient that we don’t know how this tooth will react. We don’t know if it can be saved or not. There’s so much we can discuss, and I really wanna get into protocols and decision-making and the different philosophies of managing cracks.

So before we start with all that good stuff, Masoud, tell us about yourself. What are you doing in the Netherlands?

[Masoud]
Now I’m a dentist. I’m in the Netherlands, and it’s about four or five years that I have my own dental practice. I like restoring the tooth, and the crack was the first thing that actually I didn’t know what to do. When I asked other colleagues, they said, yeah, I also see them, but you can maybe put the primer, bonding on it, just flowable. Then someone said, yeah, you can put fiber on it. But it’s just confusing and there are a lot of controversies. Someone says, yeah, you have to pull it out.

Especially when the patient comes for small restoration, you say, okay, sorry, this is gone. I saw a crack. But it was really hard for me, and I just tried to do my best for the patients to save the tooth. This crack, it should have a philosophy. It should have a way of restoring it.

[Jaz]
Like protocols to go by based on the level of diagnosis. I think there’s only one thing that for sure we can agree with cracks, one thing, and then you tell me if things have changed. If someone has a true split tooth, i.e. the fracture’s going all the way through, obviously that’s for the bin, that’s for the forceps. So that’s one thing we’d agree with. And then also if you have like five, six millimeter probing depth associated with the crack, that’s hopeless prognosis, right? Unless we’re, let’s not beat around the bush, that is hopeless.

I think most of us get that and understand that. But then there’s that gray area where the crack is one or two millimeters subgingival, or the other gray areas. At what point do we intervene? Like we have MO amalgam and on the other marginal ridge we have a crack. This could be with staining, without staining, certain widths, certain durations, they’ve been there for 20 years. Knowing when to intervene for a crack is something I’d love to talk about with you today as well.

[Masoud]
So the first thing is we have to know the depth of the crack and where it is exactly. Is it in enamel, is it in dentine? And the second point is the age of the patient, because after age 40, 45, crack can unfortunately propagate very easily. All of the fracture cases which you see, most of them are elderly patients. Not young patients, unless there is a trauma, that’s another scenario.

These two things, especially the anatomy of the tooth and also thinking about crack repair, self-healing mechanisms, are really important for our decision-making for treatment. And also about the post that you shared, that was a huge crack. It starts from enamel, goes to the deep dentine.

[Jaz]
Can you remind me what my post was? I genuinely don’t remember. What was it?

[Masoud]
Really? It was an amazing image of a crack.

[Jaz]
Was it an extracted tooth in the crack?

[Masoud]
No, no, no. It wasn’t extracted tooth.

[Jaz]
Okay.

[Masoud]
It wasn’t extracted. It was just, I think intraorally you made the picture.

[Jaz]
Okay, okay. Like an MOD black crack running through like that.

[Masoud]
Yeah. And the initiation part was really open. You see just debris and a plug inside the crack.

[Jaz]
Let me see if I can pull this up because Protrusive Guidance audience, YouTube audience, it’s nice to have a visual. For those who are listening, of course we’re gonna describe it very clearly, and it’s a nice little starting point to discuss this one scenario. Yeah, that’s an awesome image. That’s the power of sandblasting, right? When you sandblast a crack, when you air abrade a crack, you can see it, and then I take a photo and I share with my patients.

So this post was all about how I communicate cracks to a patient. For those who are listening on Spotify, Apple, if you’re chopping onions, exercising, it’s just a really nasty crack when you remove an MOD amalgam and then you air abrade it, and you literally see the white air abrasion powder track all the way. So this is a very nasty crack, absolutely.

[Masoud]
You can see that this part is actually open, and your sandblast particle is just, how do you call it, it’s just—

[Jaz]
It’s jammed, it’s trapped in there.

[Masoud]
It’s like it’s trapped there. It’s just trapped.

[Jaz]
By open you mean we can feel it with the probe. Basically, with the probe we can actually feel.

[Masoud]
Yeah, so these are actually huge cracks and it is really hard to make a decision at this point. What are you going to do? Are you going to remove all this healthy tissue here to overlay that? Are you going to chase the crack? Are you going to follow it? Why should you follow a crack? I think these are very important questions to answer.

[Jaz]
Sometimes you’re looking, the patient’s got this non-specific pain. You’re like, could it be a crack kind of thing? A point you mentioned before we hit record: we only start noticing cracks when we wear magnification and we look really closely. Otherwise, we’re oblivious. We really don’t see these very obvious cracks because we’re not wearing magnification.

I also see everyone saying since COVID, we’re noticing so many more cracks. I think you are right, what you said earlier. Can you just say what you said earlier about how we are documenting better and stuff?

[Masoud]
There are studies that show just 8 to 9% of the cracks are symptomatic, like pain on biting or cold sensitivity. The other ones, like 80 to 90%, are just asymptomatic, so we just see them during restoration. Nowadays you see on Instagram, like the image that you shared, with high quality photography, with magnification, with microscope, with good images, most of the time the crack is the first thing that we notice.

It doesn’t feel good. Everyone says something is wrong with this tooth, you have to do something, and you can’t just put your adhesive system on it and put the composite or make a beautiful overlay on it. If you also check other posts, when there is a crack, there are always comments: how about the crack, what do you think, what’s the prognosis, what do you expect from your restorations? These are the things that you start to think.

When I started to learn about cracks, actually the studies were not from dentists. They were fracture mechanic engineering. They had the tooth and they just started to break it.

[Jaz]
Like flex it, load it.

[Masoud]
Flex it, see the strain and stress on the tooth and how it’s going to break. They gave us a lot of information about crack initiation and also crack propagation on a tooth. We also have some good studies from dentists. They try to treat it in different ways, especially the crack, and share their follow-up after five years and 10 years, which restorative restoration is just the best or restorative manner for many of the teeth.

[Jaz]
All these answers to be revealed in this podcast, I hope. So let’s start with the basics. One of my mentors, Lane Ochi, taught me that cracks in enamel are not so worry-ful. Cracks in dentine are the ones to worry about. So sometimes, let’s say you have a lower first molar. It’s got a DO amalgam, and on the mesial you see a crack. Now we see the crack obviously in enamel, and it could be stained or it could be not stained. But without removing the amalgam, how can you be sure whether it’s only in enamel or is going through the dentine?

[Masoud]
It’s hard. Maybe meta transillumination can give us information. Nowadays there is a new system. It is called quantitative percussion diagnostic, QPD, quantitative percussion diagnostic. They are giving very small percussions to the tooth, and they have AI information. If the percussion is 100, then it’s good, but if it’s 80 or 70, then there is a gap. There is an opening inside the tooth.

[Jaz]
It’s kind of like when you test, I don’t do this, but when you test an implant for integration.

[Masoud]
Yeah.

[Jaz]
It gives you some data. Oh, that’s so cool.

[Masoud]
Same system as it too. But it can be also because of a gap in a restoration. So if there is a gap, the information will change.

[Jaz]
False positive.

[Masoud]
Yeah. So the first thing is crack or the gap, but it’s still really hard. So always in old articles, the first recommendation is removing the existing restoration.

[Jaz]
I think that could be aggressive because there are some guidelines. For example, if you see a crack, and obviously like you said, 90% are asymptomatic, but if it’s not stained and you can just about see it with magnification but you can’t see it with the naked eye, then maybe that’s gonna be okay. But when it becomes stained, at that point we know that it’s big enough to allow stained particles and bacteria to go through. That is one thing I’ve seen cited in literature, that if it’s stained—

But my patients in their sixties, they all have cracks. If we chased every single crack, literally we’d be seeing like two patients a day and that’s all. That’s how I say it to my patients: you have cracks, exactly two cracks.

[Masoud]
It’s just, the crack belongs to tooth, so we have to know which crack, when we have to interact or not. Another point is use a fluorescence filter. Fluorescence filter shows us where bacteria are. So if you have a crack you doubt, you can just use the fluorescence filter.

[Jaz]
This is black light, this is like a UV torch, right?

[Masoud]
It’s not UV. It’s a fluorescence mode. You can have it on your microscope.

[Jaz]
Fancy microscopes.

[Masoud]
Yeah. There are also cheap ways, like in your loupes, or you can just have an extra oral light and then check it. If there is bacteria, the byproducts of bacteria become red, and in this way you can see if the crack is red or not, or is there bacterial biofilm in the crack or not. I also shared some posts about how you can check it, and that really makes it easy to check the cracks, and then you can start to remove it.

There is also a study from, I think, Ricucci, and he says when the crack is connected to oral environment, it is actually filled with bacteria and biofilm, especially if the crack is in dentine, because dentine is more flexible. It can open and close, so there is space for bacteria to invade. When it is in enamel, it’s more rigid, it’s harder. So the crack faces are mostly just touching each other. It’s called closed crack. In that way, there is almost no space for bacteria to invade inside the crack. That is also one of the reasons that we are not removing the cracks in enamel.

[Jaz]
But like you said, it’s difficult to tell. Let’s look at some metrics then, some clues. Some clues could be that the crack is stained, that we’re gonna use the fluorescent lighting to see if there is bacteria inside. But we also have to look at the patient. If they’ve got big strong muscles, if they’ve got a history of losing teeth before due to cracks, that is a very significant prognostic factor for me for should we treat this asymptomatic tooth or not. If they’ve lost teeth to cracks before, this is a really big deal.

Of course, if the opposing tooth has already been extracted, then that crack is not gonna propagate, so you don’t need to worry about that. You have to remember that this tooth, this crack is in the patient’s mouth, and look at the patient as a whole.

[Masoud]
Yeah, that’s right. I had a patient, she broke the second upper molar and there was no restoration on it, and it was just fractured. After three or four years, I saw a vertical crack on second upper molar. I said, yeah, we have to do something, otherwise you’re just going to miss this one. Indeed, big muscles.

[Jaz]
Big masseters.

[Masoud]
High force patient.

[Jaz]
These patients I’ve seen. I remember seeing quite a few. I document these cases really well because it always fascinates me when I get that. A few times a year I see a first premolar usually, or a second molar with a virgin crack without any restorations, and they come in irreversible pulpitis. It’s like, what’s going on? You start drilling into the tooth and you see this crack opening and opening and opening, and it’s fascinating.

They all have this thing in common whereby either their premolar is very cuspy, the angles are very acute in their premolar, and you can imagine that’s flexing. Steep cusps, that’s been a risk factor I’ve noticed. The other one is, of course, these clenchers, these high force patients with large muscles, because muscles matter. Force transmission will be different for each of these patients.

[Masoud]
Yeah, and also their distance to TMJ, because there is also a nutcracker effect. On the distal side of the second molars, upper and lower, we always see a vertical crack. Usually if the patient is like 50, 60 plus, just make an intraoral image and put it in the document of the patient. It’s always there. Also the upper premolar, because of its position, its anatomy, it’s just always going to break vertically from the furcation stress plane.

[Jaz]
Often see the palatal cusp completely come away, and then when you take that fragment out, you see four millimeters of root come out with it. I think all dentists have seen this. We get that a few times a year. It gives us another reason to remember that just because it’s asymptomatic doesn’t mean we should just leave it. We need to make a timely intervention.

So let’s circle on this and make some clear guidelines for dentists. Masoud, when should we be intervening? What’s the best evidence that we have so far about intervention? Obviously we spoke about patient factors, the muscles, the history, the anatomy of teeth, but any other guidelines: you can intervene when this happens?

[Masoud]
The first point will be symptomatic pain on biting. It’s called rebound pain because the fragment is going to move and dentinal fluid is going to fill the gap. During unloading, the fragment will come very fast and it will cause pain. If the crack is symptomatic, it should be treated because it shows that the crack is propagating.

The second one is also cold sensitivity. It can also be the same reason. The other ones are all dentinal cracks, especially if the patient is 40 plus, because dentinal cracks are structural cracks and enamel cracks are non-structural cracks. So if the patient is 90, there are a lot of cracks in enamel, we don’t need to treat them, only if the patient wants good aesthetics because the craze lines can get stained, become black, and maybe they don’t find it beautiful.

But the dentinal cracks are structural cracks and they can propagate. The reason is in its anatomy and histology, because dentine has its own mechanism to stop a crack. It’s not like dentine has no mechanism and the crack can just go. This crack can be there for 10 years, 20 years sometimes, but dentine has its own mechanism to stop the crack. At some point it’s not working anymore. 

The reason is when the dentine tubule becomes closed, it is called sclerotic dentine, and all the collagens work together to create crack bridging to stop crack from propagating. But the collagens, when we get older, they are gluing to each other. It is called cross-linking. In that way, the crack can propagate more easily.

When there is a crack in a young patient, if he or she is not 40, I will not remove it. I will also check if there is bacteria or a plug inside it, but if not, I will just leave it there.

[Jaz]
Unless, and I love that you said that. However, I have this 19-year-old patient. She’s now 23, but when I first intervened on her, she was 19. She had that first rule that you said: she had symptoms. This is a high force patient, very rare to see a 19-year-old high force, huge masseters. Destroys her Essex retainers in a year. Now she’s wearing appliances, and it’s taken her three years to destroy that virgin crack in a molar, symptomatic. When I traced it, you can see the crack beautifully.

Once I restored it with a class II composite, because actually it didn’t warrant anything more than that, the similar thing happened a year later, symptomatic on the left symmetrical molar, and now things have been stable for some years. As a rule of thumb, yes, young patients’ dentine can probably handle it, but there are times where it may become symptomatic, and in that case we need to go case by case, I think.

[Masoud]
Yeah, and I think in that way we also have to remove the reason. What was the reason? Was it bruxism? Was it because of the anatomy of the antagonist or the tooth? Because there is a stress concentration in that point where the crack is started. So we have to distribute the stress in that place, in that plane. That is the important one. If we are just going to remove the crack and put the restoration on it, I’m afraid it’s just going to happen again.

[Jaz]
I love that you said this, and I’m nodding. What we had to do in this patient is, she had these crazy wear facets, so I had to do some adjustment. I had to do some selective grinding. This is force modulation. We might be removing microns of enamel to save millimeters of dentine and keep the teeth going as much as possible.

Instead of having the occlusion on a very steep incline, I had to flatten it a bit to make sure the stress distribution is better. I had this plunger cusp type on the opposing, I had to reshape it so it’s a bit more gentle. I had to remove a very steep incline and flatten it. I’m so glad you said that because if you just replace it, it will also have a marginal ridge fracture, which this one did, a tiny little marginal ridge fracture, which wasn’t a big deal, but it just goes to show that you have to do some sort of force modulation.

[Masoud]
Yeah, or maybe using nightguard.

[Jaz]
She does.

[Masoud]
She’s a bruxist. I think also the final restoration is really important. There is a recent study from 2021. If the modulus of elasticity of the final restoration is close to enamel, the crack underneath will not propagate. It will just stop propagating. When you are restoring with composite, your modulus of elasticity is about 20–22 maximum, but the enamel is about 80. So if you use a restoration like a ceramic restoration, gold, with gold they also got good results.

I don’t know if it would be possible to share also these studies. I can send it to you.

[Jaz]
Oh, please. Our colleagues love to geek out on the studies. Send as many over. We’ll put it as a downloadable document.

[Masoud]
I will send it to you. They restored a cracked tooth with different kinds of restoration, and they checked when the crack is not going to propagate. They saw it’s happening when the modulus of elasticity of final restoration is close to the enamel. Actually the biomimetic concept: just try to mimic the nature.

[Jaz]
Like lithium disilicate, for example. In that specific patient, she was 19, so I did a direct. But if she was 20 years older, I would’ve gone for my usual protocol: good bonding under rubber dam with lithium disilicate, and maybe even at that stage be a bit more in terms of capping cusps where appropriate. We can talk about that as well.

[Masoud]
Yeah, because the form of the cavity is also important. In young patients, most of the time the cavity is not that huge. There is no place for indirect restorations. If it’s a small class I or really small class II cavity, I would also go for direct composite. But in huge restorations or multiple cracks, most of the time they’re just following each other and you see multiple cracks in one tooth. In that way, I think we have to choose the final restoration very clearly, a very good final restoration.

[Jaz]
So gold is approved, makes sense, and good bonding with ceramics. Are you including zirconia in that?

[Masoud]
Actually not, because zirconia has very high modulus of elasticity. It’s about 200 gigapascal and enamel is about 80. The second one is the bonding, because you lose your bonding strength in zirconia a bit faster than in lithium disilicate. These are the reasons that I’m not using zirconia. I’m using mostly lithium disilicate. But I see also dentists getting good results with zirconia and I understand that.

[Jaz]
Okay, fine. So we talked about which cases to intervene, why to intervene, why most of them are asymptomatic, but you gotta pick and choose the ones where it’s more likely to be in dentine. Look at the patient as a whole. Let’s talk about operative procedures: chasing cracks.

Back to the image that we shared, to what degree should we chase cracks? Because if you keep chasing, you’re gonna hit the pulp and then you’re gonna do an endo where you could have avoided the endo. That’s an easy one for us to understand. But are there any clear guidelines? We have caries removal endpoints. Do we have crack removal endpoints?

[Masoud]
That’s right. If it’s a non-vital tooth, I would remove all of it if it’s possible. If it’s a vital tooth, I will save the pulp. I will not expose the pulp. I will do my best to not expose the pulp. I will leave the crack on the center part and I will put fibers on it. In the peripheral zone, I try to remove it.

Unfortunately, most of these cracks are stopping at bone level, so it means that you have to deal with a very deep margin elevation or very deep margins. These are really hard to get a good adaptation between the matrix and the margin of the tooth. It’s really deep, it’s really dark, so you have to be sure that your light is going there for polymerization.

Most of the time they have a really high C-factor because it’s like a tunnel, a very narrow tunnel. The composite is going to shrink very badly. These are things that we have to think about: try to minimize the C-factor or the shrinkage stress and know that we have to deal with very deep margins.

The first reason that I am going to remove a crack is if it has a connection with oral environment, and if there is plaque there, it will invade inside. That will be the first reason. The second one will be crack propagation, because the crack tip has the most stress there. There are some studies, finite element analysis, if there is a crack, the crack tip is just red, all the stress is there, so it will propagate. By removing it, I can’t be sure that it’s not going to propagate anymore.

[Jaz]
I think to add to that, Masoud, I went through ebbs and flows of chasing cracks, not chasing, because I hear both camps. I hear what they’re trying to say. I think whenever there’s two extremes, you have to go down the middle and your answer’s somewhere down the middle.

Basic things like if you’ve got a crack on a marginal ridge, if you don’t at least address that crack, then that’s where you’re gonna get caries. It just makes sense. Also, you need to have access for your bur, access for your matrices. So that interproximal bit has gotta go, the proximal wall.

Then you’ve got to look at biological limits, pulp being one, but also connective tissue being the other. Kind of like how we don’t go into the pulp, the crack will get thin enough and you might accept, now the crack is thinner and I’m not gonna chase this anymore because you’ll compromise the restorative seal or result that you can get.

The other thing to consider there would be, when you are chasing these cracks, the most important part of the crack is the tip, like you said, that’s where the energy is. But if we can reduce the height of these cracks, we reduce the energy that goes to that tip. I think if you follow those principles of making the cavities cleansable, restorable, preserving pulp vitality, I think that’s a good middle ground.

[Masoud]
Yeah. So if I also adopt and I can’t remove it anymore, and it is white crack, I’m also stopping. Sometimes it’s so deep, my bur is not going to remove it anymore. I can’t touch it anymore. The good point is, thanks to the study of the engineers, when the crack is in root dentine, it’s not going to propagate that fast. Crack in coronal dentine propagates faster than in the root dentine, and this is really interesting.

[Jaz]
I didn’t know that.

[Masoud]
Yeah, I also didn’t know that. When it is in the root dentine, it’s just not going to propagate that fast. I will also share this study. I used all of this in my book. When I read it, I thought, this is mind-blowing.

[Jaz]
Well, let’s go to that thing then about healing cracks. You’re at that scenario where you’ve removed the height of it, you’ve cleared away the caries, you’re now not gonna expose the pulp, and you’ve reduced the height. You may be gonna cap some cusps, remove that couple millimeters of the cusp to make it lower in height so it’s less flexing. That all makes sense. But then at that point, how can we wave that magic wand and heal the crack like bone? You said we can heal the crack like bone. What do you mean when you said let’s heal the crack like bone can heal?

[Masoud]
When I read it for the first time, I thought, is it really possible? But it is possible. Like how there is a crack healing mechanism in the bone, there is also crack healing mechanism in the tooth. The difference is the crack healing mechanism in the bone is because of regeneration. You have a multi-step physiological process: inflammation and hematoma formation, bone remodeling, and at the end regeneration, and it is because of the blood supplies, because of the blood vessels there.

In the tooth, in dentine and enamel, we don’t have blood supplies. We don’t have blood vessels, only in the pulp. But interestingly, there is a crack healing mechanism in the tooth. It is different in dentine and also enamel. Knowing the histology and anatomy is really important.

The studies also show it is different in inner enamel than outer enamel because of the inorganic and organic matrix of the enamel: hydroxyapatite, the protein. The crack healing mechanism is different in inner enamel and outer enamel.

The first study is from 1949. He is called Sognnaes, 1949, and he thought the enamel tufts are actually cracks that are getting healed. Then no, it’s just hypocalcified intrinsic defect. After that, in 1994, Hayashi thought that there is mineral deposition inside the crack, especially enamel cracks, and these are medial cracks on occlusal part of the crack, and there is mineral deposition inside the cracks.

Myoung in 2009 saw even the protein-rich fluid can go to the crack and it can cause adhesive interlayer. It means two crack faces are going to glue to each other because of the protein-rich fluid. In 2013, Rivera and Arola, an engineering group, saw even that the length of crack is just going to decrease because of the healing mechanisms of the enamel of the crack.

[Jaz]
Increase the crack length?

[Masoud]
Decrease. Sorry, decrease.

[Jaz]
Okay, I’m with you. Now it’s making sense. It’s good to clarify. It shows you that I’m listening. Crack length is decreasing now, I get it. Now I’m totally on board.

Before we move on to dentine, you say all these wonderful things, but this is all just happening with saliva and the oral environment, or is there something we can do as dentists? Because we like to do things. How can we accelerate this? How can we create an environment conducive to enamel crack healing?

[Masoud]
That’s a good question. What’s the important point? It’s saliva. So be sure that your patient has not xerostomy. Stress can reduce saliva. That is the important part. After that, it is starting from the first moment that there is a crack. After 48 hours, they started to see that the crack is just decreasing, like it’s just healing.

Can I share that study with you?

[Jaz]
Yeah, talk about it.

[Masoud]
Indentation Damage and Crack Repair in Human Enamel.

[Jaz]
So it is legit. He’s not talking out of his ass. He’s being honest. This is cool. This is the geeky stuff we like on here.

[Masoud]
Look at this.

[Jaz]
We are seeing the crack length decrease after 48 hours. But this is in vivo or this is in vitro, like they extracted tooth?

[Masoud]
Yeah, this is extracted tooth. They don’t have it intraorally.

[Jaz]
You can’t measure that intraorally.

[Masoud]
No. I think intraorally, if they want to see, we have craze line and we have internal craze line. I think it would be possible to see that the internal craze line is going to get repaired, starting to get removed, disappear.

[Jaz]
There’s really nothing for us to do. There’s no special toothpaste. It’s just good to know that human enamel can have these self-repair mechanisms as long as you have a healthy patient, i.e. good saliva.

[Masoud]
Yeah, and also if we have a healthy pulp, because interstitial fluid has also effect on crack healing. Crack can propagate if it’s dehydrated, like in endodontically treated tooth, or when there is xerostomy. So it’s really important to keep the pulp vital.

[Jaz]
That’s what they say because it becomes brittle. All the chemicals that we use for root canal and everything, the tooth itself, when extracting a root filled tooth, it just feels different, feels more sclerotic, feels drier. That’s got to have something to do with it.

Fine. Then are we gonna talk about, is there any healing mechanism in dentine?

[Masoud]
There is also the healing mechanism in dentine, and it is also remineralization. The other very important point is the collagen matrix. The dentine is filled with the collagen matrix, and this collagen matrix is like a scaffold for ions, for phosphates and calcium, to come inside the crack.

The problem in dentine is because it’s flexible, so the crack is opening and closing, and that makes it really difficult for crack healing mechanisms. If the patient is old, 40 plus, the tubules become closed, so there will be no interstitial fluid to remineralize. Also the collagen matrix starts to glue to each other because of cross-linking, so there will be no scaffold for the ion transport. That will be the problem. Dentine has also its own mechanisms to get repaired.

[Jaz]
But there’s nothing we can do to promote this bone-like healing.

[Masoud]
No.

[Jaz]
And obviously most of the cases we see too late.

[Masoud]
Image you shared, there is no mechanism there. It’s really over.

[Jaz]
Well, let’s talk about that right here because you mentioned fibers. I don’t use fibers at the moment, but if there’s enough good clinical long-term evidence, I will. Of course I will join the party. You sound like you use fibers over cracks. Can you mention that? To someone who’s never used fibers and never done it justice by looking into it that much, I’ll be honest, what’s up with that? What are fibers doing? Is it robust enough? Is it strong enough? Do we have any good long-term data that the cases managed with fiber versus the case managed without fiber?

Obviously so many different variants and you can’t control for what the patient eats and clenching and that kind of stuff. But as a whole, where are we at with how far into its acceptance in the literature and acceptance into widespread practice we have these fibers, which we see so nicely on social media layering over these cracks in a criss-cross pattern?

[Masoud]
When there is a crack, there is a lot of stress there, so we have to do something. We have to redirect the stress. We have to distribute the stress, so it’s not just going to concentrate in one place. The fibers are the best way to do that. Putting the fibers on the crack.

In a vital tooth, the best way is laminating, like putting one piece of fiber on it. In an endodontically treated tooth, the best way is annular layering, like in a circle form shape inside the pulp chamber. There are two types: we can use glass fiber or we can use polyethylene fiber, the Ribbond. It’s about how they are, bidirectional or unidirectional. The fibers like Ribbond, we have to pre-wet it. It’s not ready to use. But the glass fibers are mostly treated, they are ready to use, and we can put it on the crack or where we want.

We can use fibers in dentistry in three ways. Strengthen the restoration: if it’s a huge composite restoration and financially it makes it a bit difficult for patient to pay for indirect, you can put fibers inside your restoration. 

In that way you can strengthen your final restoration. We can protect the hybrid layer. The hybrid layer, the first minutes, is really sensitive to stress like shrinkage stress, and by putting fiber on it we can create a fail-safe protocol. It is not going to fail at that point anymore. And we can also strengthen the tooth, especially if there is a lot of sound tissue gone or removed, or if there is a crack, we can strengthen it with the fiber.

I recently read a study. They checked the fracture strength of natural teeth without restoration and also checked the fracture strength of a tooth with a crack, upper premolar. The intact tooth had about 1,200 Newton, but the tooth with the crack was about 400 Newton. So it was three times more brittle, it can fracture easier than the natural.

So in this way, with the fibers, you can redirect the stress which is coming to the crack.

[Jaz]
Do they have any such scenarios where they take that premolar and now chase out the crack as you would do, and then put the fiber on it, then restore it, and then put it under the same loading? It would be nice to know how many Newtons it can take. We’d expect it to be more?

[Masoud]
Yeah, it’s about 3,000.

[Jaz]
What?

[Masoud]
It’s about 3,000. You make it stronger than a natural tooth, actually.

[Jaz]
No way. You have to send this paper. That’s pretty cool. There’s process-based reasoning and there’s outcome-based reasoning. Process-based is like, by doing these fibers, by doing this, we’re strengthening the tooth. But what we care for more is outcome-based reasoning. For example, because we did this, my teeth are lasting 30 years, whereas before they were lasting 20 years.

We’re doing this more complex thing at an added expense, added time. We know there’s more risk involved in terms of you might mess it up, more time consuming and stuff as well. Whilst that sounds awesome, where on the benchtop we can get that data, and I think that says something, that’s pretty cool.

I didn’t know that, and I think there’s a lot of things in dentistry which we look at, we don’t have any clinical reasoning for, but it makes sense in a physics way, and a lot of occlusion is like that as well. A lot of the adjustments I do are based on that, so I’m not averse to it. But it’ll be nice to have any clinical data to support how it may be superior and therefore it can justify the added expense in terms of time and materials to a patient. Where are we now in terms of waiting for that kind of data?

[Masoud]
Not really that much. Endodontists are sharing more cases, more follow-ups, especially in crack removal. One is Philipson. I think I also had contact with him for writing my book. He shares that with removing the cracks, he sees that the teeth are going to live for 10 or 15 years, and this is why he’s supporting the idea of crack dissection. He’s dissecting the crack from 10 millimeters. 

He says, okay, after dissecting the crack, there is the solid pocket from 10 millimeters. He’s putting Biodentine or MTA there. The x-rays look very crazy. I will never do it, but he just wants to save it. He made very good publications about it. It is really amazing to see how crack removal works.

But in terms of using the fibers and the long-term follow-ups, unfortunately I couldn’t find anything the way we have about the crown and cusp overlay, like removing all the cusps and onlay and then you see good results. We also have a study with crack removal, I think it’s an Australian study. It also shows in five years, 100% survival after removing the cracks.

[Jaz]
What do you mean by that? Sorry, 10% increase or 10% survival overall?

[Masoud]
They had no failure. The teeth were not extracted. All were just still in the mouth.

[Jaz]
They had 100% survival.

[Masoud]
100% survival.

[Jaz]
Okay, cool. But then that’s a very aggressive way. Based on what we’re learning from that study, should we be adopting that?

[Masoud]
That’s a good study. There are not that many studies. Unfortunately, like in adhesive dentistry you have thousands of studies. When you search about the primer or bonding, you get a lot of stuff.

[Jaz]
But in that case, you said they have to do endodontics, which makes sense. If you’re chasing all the cracks, you’re gonna be doing endo more often than not.

As Pascal Magne says, the root canal treated tooth will never win the Olympic Games of restorative treatment. Whilst that’s an interesting study, I don’t think I would change my way. I wouldn’t go too aggressive totally chasing all the cracks. Would you agree with that?

[Masoud]
Yeah, I would also not do it.

[Jaz]
In five years we need more, we need up to 20 years plus. We need to compare it to, is it better than what we’re already doing? I think you’ve mentioned some great points. Masoud, you’ve answered all my questions. It was really fun to speak with you. I would love for you to tell us about your book. You mentioned your book a few times. I’ve seen it on social media. Tell us about it, because it is no easy feat to do a book. I’m doing a book at the moment. I know it’s no easy feat. Tell us about it.

[Masoud]
Yeah, this is my book, The Cracked Tooth.

[Jaz]
Oh, sweet. Is this a different one to the one that you had on?

[Masoud]
No, this is the one. I also published another one that was the Glossary of Biomimetic Restorative Dentistry.

[Jaz]
That’s the one I saw. Oh yeah, that’s the one I saw. Okay, cool.

[Masoud]
This is a new one from this year. This is only about cracks in tooth and what we have to know about it, with all references at the end of each chapter.

[Jaz]
That’s amazing. Oh man, that’s so geeky. I love that, Masoud. Well done. That must have taken so much time and effort. Really well done, mate.

[Masoud]
Yeah, it took almost three years to do it. First I had to study a lot and I had to make all the connections with the engineers. Actually, how does it work? I really didn’t understand. There is a Paris law in fracture. In that way they can measure crack propagation, but the problem is they have a continuing mechanism. It means point A and point B have the same chemistry and physiological properties, but in the tooth each half millimeter is different.

So it makes it really difficult for the engineers to calculate the real crack propagation in a tooth. They have to divide it to deep dentine, intermediate dentine, superficial dentine, inner enamel and outer enamel. With my book, my idea was making a very small book at 90 pages to share with my colleagues, to share my information with them, but it became 400 pages. Still there are studies, some of them I read some weeks ago and I said, maybe I should put this study also in my book.

[Jaz]
Volume two, that kind of stuff. Masoud, is this on Amazon?

[Masoud]
This is on Amazon, yeah.

[Jaz]
Alright. Please send me the link. I would love to share it with Protruserati. I think what you said was making a lot of sense. I like that. The only unanswered question I have is the very first few things you mentioned about the percussion-based diagnostics. Is that like a special tool you have to buy?

[Masoud]
Yeah. It is called InnerView. The links are very interesting. The first dentist who called the crack in dentine structural was David Clark. David Clark wrote a study in 2003 with Challis, and Challis invented this instrument. It is called InnerView. In this way, you can measure if there is a crack in a tooth or not. I will show image of it.

[Jaz]
I like the idea of gaining objective data. It’s why I bought the T-Scan in occlusion. I like the timing data, the force data. This is another thing that can help you, like transillumination, to get more data of should you intervene, should you not. I like that.

[Masoud]
Yeah, it is really—

[Jaz]
Is it an expensive toy, Masoud?

[Masoud]
Yeah, I think it’s about two or three thousand.

[Jaz]
Yes, it’s an expensive toy.

[Masoud]
Two or three thousand dollars.

[Jaz]
Is there an AliExpress version? No, I’m just kidding.

[Masoud]
I know there is a first version and another team tried to make it, but it’s not that easy to use. The idea of InnerView is you have a pen and you’re going on each tooth and you can test it.

[Jaz]
It’s like you’re describing a Tooth Slooth in a way.

[Masoud]
Yeah, like that. But this one is going to tap or send a percussion on the tooth and get the info back from the tooth. It is now waiting for ADA approval from USA. I think they’re waiting this year or next year to bring it to the dental shops.

[Jaz]
Amazing. Now that I know about this pricey device as well, this data is cool. I didn’t know about that before. I didn’t know that root dentine is more resistant to cracking. That was fascinating. I didn’t know about the epic impact of these fibers on these extracted teeth. That’s really cool to know. I didn’t know you had that book on cracked teeth. That is awesome, and I’ll put the link there for everyone to check it out, to see all your hard work.

Masoud, thanks for sharing so generously with the community. We really appreciate people like you doing the work that we don’t want to do, all the hard work and reading, then sharing all the answers with us. We really appreciate you. You’re the kind of guy whose homework we copied.

[Masoud]
Thank you.

[Jaz]
Thank you so much, Masoud, for all your work on cracked teeth, and I’ll put all the papers that you send in the blog link. I’ll put your Instagram. Please tell us about your Instagram.

[Masoud]
On Instagram, I started just sharing normal things. I had just 100 followers. Then I started to share my daily challenges. Look guys, this is the thing that I am dealing with and I have to do. Now it’s about 400, 500 posts that I made with really difficult situations, and I always get good answers or good reflections, feedbacks: hey, you are sharing the things that I maybe didn’t know how to do. Now I have more ideas.

With the last years, I make all the images with the microscopes. They are 28, 29 times magnified. It gives more information. You can really see the mantle dentine. You can really see the inner enamel. You can see the outer enamel. 

You can see the histology difference between these two, also where we call the dentinal enamel junction. I also share images with fluorescence mode, fluorescence filter. You can see where the bacteria are and where you have to remove. Not all the length of the crack is filled with bacteria. When it is closed crack, there is no room, even in dentine.

I shared a case when I started to chase the crack, and each millimeter I made the image with fluorescence mode. You see after two or three millimeters, it’s not red anymore, it’s just clear. But the crack is still there. So it means the crack spaces are so tight connected to each other, so there is no space.

[Jaz]
So it’s like the width of the crack is getting less, which makes sense. The crack would be higher, more open at the top, and as you go more cervical, it would get thinner and thinner, and that makes sense.

[Masoud]
It is called transition. We have three types of cracks. One is closed crack. All the crack faces are just connecting, like crack in enamel. Second one is transitional crack. These are like the first point, the initiation part is open, but close to the tip the crack is closed. The other one is totally open crack. In dentine, we see most of the time transitional crack. The first point is open, and near the crack tip it’s closed. When it’s open, there is space for bacteria and biofilm to go there.

[Jaz]
Amazing. Everyone, do check out Masoud’s Instagram. I’ll put the link below. Masoud, thanks so much, my friend. Have a delightful Friday, and I can’t wait to publish this. I’ll give you a shout out, my friend. Thank you so much.

[Masoud]
Thank you. Thank you. Thank you, Jaz, for your time, for invitation, and sorry for messing up a bit with the increasing and decreasing.

Jaz’s Outro:
It’s totally fine. I was thinking in my head, okay, when’s the right time to intervene? And you nailed it. Thanks so much for a wonderful summary on cracks.

Well, there we have it, guys. Thank you so much for listening all the way to the end. I know you want the papers. Scroll down below. If you’re on Protrusive Guidance, they are all there. 

If you’re on YouTube, check out the WordPress link and again, we will have them all there for you to download. The easiest way is to head to protrusive.co.uk/cracks. That’s protrusive.co.uk/cracks. Our manager, Alex, is going to zip all these papers that Masoud sent us and send them to you. We’ll also send you a link to his book on Amazon. I think it’s amazing that he’s done this, and if you wanna geek out with him more, check out his book. I’ll also put his social media.

Of course you can get CE for this. You’ve done the hard work. You’ve listened, you’ve watched, you can get CPD or CE credits. We are a PACE-approved education provider. The only way to get CE for this is on the Protrusive Guidance app. You need at least the CE plan, which is amazing value. Dentists are getting 100 hours of CE every year just from listening to the podcast while they’re commuting and answering the quiz on the app.

If you wanna get the full fat version and get access to Vertipreps for Plonkers, the 21-day Photography Challenge, Rubber Dam, premium clinical walkthrough videos, all that good stuff is on the Ultimate Education Plan. Check it out on the Protrusive Guidance app.

Once again, if you’re fancy coming to Dubai with us, it’s globaldentalevents.co.uk. You click the button to get a quote. You have to say how many people are coming. Is it you and a spouse, or you and spouse and kids, or just you? 

Then you get some hotel options and flight options, that kind of stuff, and you get a quote that’s going to be tax deductible because it’s for work. Remember we are going to learn occlusion and have some fun. So globaldentalevents.co.uk. I’ll put the link, everything you need in the show notes.

Thank you so much for listening all the way to the end. Honestly, it means so much to have your listenership and engagement on all the platforms, including Instagram and stuff. Thank you so much and catch you, same time, same place next week. Bye for now.

With the final places remaining for our Occlusion Getaway, we present the official FAQ Podcast!

Dreaming of combining occlusion learning with a luxury getaway?

Want to earn 56 hours of CPD while soaking up the Dubai sunshine?

Looking for a course where you can master PRACTICAL occlusion in Restorative Dentristry and make it a family-friendly, tax-deductible trip?

Easter 2026 is set to be unforgettable. Join Dr. Jaz Gulati and Dr. Mahmoud Ibrahim for an extraordinary Occlusion Excursion in Dubai — a blend of serious CPD and sunshine that redefines what “continuing education” can be.

We’ve always believed in mixing work and pleasure, and this time, we’re taking it to the next level. Think luxury, learning, and laughter — all under the warm Dubai sun.

Watch IC062 on Youtube

🦷 What Makes This Course Different?

Bring your family (Easter school holidays!) or come solo — many dentists are already flying in from around the world.

REQUEST A QUOTE – Limited Places Remaining as of November 1st 2025!: https://globaldentalevents.co.uk/ 

Spaces are limited and flights are rising, so secure your place early.
👉 Easter 2026 – Occlusion, sunshine, and CPD in Dubai.

📅 28 March – 4 April 2026

📍 Dubai, UAE

👨‍⚕️ Dr. Jaz Gulati & Dr. Mahmoud Ibrahim, Organised by Global Dental Events

Highlights:

Do all whitening gels work the same, or is the brand actually important?

Are lights and in-office “power whitening” just marketing hype?

And what’s the deal with the infamous white diet – do your patients really need to give up coffee and red wine?

In this episode, I sit down with Dr. Wyman Chan, the man who literally hung up his drills in 2002 to dedicate his career to whitening alone. With over 20,000 cases under his belt (and a PhD in the science behind it), Wyman shares his three golden rules for whitening success: trays, communication, and conscious bleaching.

We’re also joined by Dr. Niki Shah, who brings his own insights into whitening and patient care, making this a conversation packed with both science and clinical experience.

Wyman introduces his latest invention—Magic 3, a fizzing gel that reveals and removes plaque while calming gums. Plus, Wyman busts some of the biggest whitening myths (sorry, “white diet”) and explains why he no longer bothers with internal bleaching.

If you’ve ever wondered how to make whitening safer, more predictable, and less stressful for you and your patients—this is the episode you’ll want to tune in for.

Protrusive Dental Pearl

Innovation in Hygiene with Magic 3 – What is Magic 3?

Clinical Application

Learn more at https://protrusive.co.uk/magic3

Need to Read it? Check out the Full Episode Transcript below!

Key Takeaways:

Highlights of this episode:

Discover Magic3 and Dr. Wyman Chan’s inventions

If this episode piqued your interest, continue the whitening theme by listening to PDP199 “How To Eliminate Sensitivity During Teeth Whitening”. And don’t miss the upcoming visual follow-up to this episode!

#PDPMainEpisodes #BreadandButterDentistry

This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance.

This episode meets GDC Outcomes A, C, and D.

AGD Subject Code: 780 – Esthetics/Cosmetic Dentistry

Aim: To deepen dentists’ understanding of teeth whitening by exploring evidence-based protocols, tray design, and methods to reduce patient sensitivity. It also aims to challenge common myths and introduce innovations that can improve both patient comfort and clinical outcomes.

Dentists will be able to:

Teaser: What is the three most important features in getting a good whitening result? Number one, because- is it true that patients should try a white diet when having treatment?

Teaser:
I heard of that when I was started bleaching 30 years ago- because I don’t have the drill anymore. They say I can’t do internal bleaching. It’s just because I give myself restriction. I have no drills at my clinic. If you’ve got a good protocol, it works- like I can show you some cases just two weeks. It’s amazing result. Get from a C4 to B1, just two weeks.

Two weeks for Tetracycline staining.

This is a colorless plaque indicator. Remove plaque at the same time. Also reduces gingival inflammation. They say we have nothing like that.

Is this solution a substitute for mechanical plaque?

It’s substitute for mechanical cleaning. To me, there’s no need to do polishing.

Jaz’s Introduction:
Protruserati. We have got THE Wyman Chan and how I pull this off, this is the guy who I’ve been watching the whitening space for so many years, and actually he kind of disappeared. Where did Wyman Chan go? Was on the lips of every UK dentist for so many years. But guess what? He is back. Alright, lemme tell you about Wyman Chan.

This guy hangs up his drills in 2002 to solely focus on teeth whitening. That’s it. Imagine that. Right at a time where teeth whitening wasn’t even like a proper thing. So since then he’s been like whitening the teeth of celebrities and all the famous people will go to a central London clinic, get their teeth whitened by him using his formulas, his patented technology and his knowledge.

Like he’s a PhD and he’s so passionate about teeth whitening. The guy’s done over 20,000 whitening cases. I was actually thinking. I don’t even think I’ve seen 20,000 patients in general in my career so far. So that just tells you the volume of teeth whitening he’s done and he’s like a mega geek. Like what he doesn’t know about whitening is not worth knowing.

So we take advantage of that. I literally ask him all of your questions that you submitted on Protrusive Guidance, the usual stuff like is the light thing, is it a fad or is there some science behind it? Do you need to adopt a white diet two hours after whitening to make sure that you get a good effect from teeth whitening?

Like that’s all standard. We actually talked about it before, but we revisit it in this episode. But of course, every episode we have a game changers and there’s a few game changers. About three, well, there’s more than three, but the three that are top of my mind right now while recording this introduction.

One is that for non vital bleaching, imagine you get that black central incisor. Usually the way I would treat it is make sure that the root canal treatment is good, and then re-access the access cavity of course, and place my gel inside and whiten from inside and also outside. Now, what Wyman Chan discusses is a protocol of not doing the internal part of non vital bleaching, doing it externally only, which is very fascinating.

The other cool thing he teaches in this episode is this concept of conscious bleaching, which I’d never come across before, but it makes so much sense. It is the number one thing that reduces and eliminates sensitivity. And I’m a little bit upset that no one told me before. It just makes so much sense. I can’t wait for you to listen to this episode and learn about what is conscious bleaching.

Dental Pearl:
And the final game changer is today’s Protrusive Pearl. Hello, Protruserati. I’m Jaz Gulati. And every PDP episode we give you a Protrusive Dental Pearl, something to reflect on, something to digest, something to apply to your patients right away. We have all sorts on here. And today’s pearl is about innovation.

Wyman Chan is just like this awesome guy in whitening and he has got so many patents I didn’t even know about this. And one new invention he’s come up with is called Magic three. So remember I said that Wyman Chan went missing? What I meant is he went to China, okay? He went to to Asia, developed a whole bunch of things and protocols, and does loads of teaching there.

And he is launched some products there as well as in Dubai. And now he’s bringing Magic three to the UK. And so in a nutshell, ’cause I don’t wanna take up too much time here, I really want you to listen to this episode, but essentially Magic three is this like colorless gel. It’s this clear gel that you put on the teeth, and then if there’s plaque anywhere, it’ll start fizzing.

So they call it a colorless plaque indicator, which sounded really crazy to me. I still calling that my head around it and the way I understood it and seeing the product myself, it just fizzes when there’s plaque. So it is indeed a a plaque indicator in that way you’re looking for fizzing. What it does is it cleans the teeth.

It replaces your polishing stage. For many patients it replaces your scaling stage. So if these are regular patients that you’re seeing every six months in hygiene and you haven’t got like mountains of this hard calculus, then this gel actually replaces your hygiene work. And the reason why that piqued my interest is ’cause I get patients coming to me all the time and they say they just don’t like the ultrasonic scaler and my poor hygiene is that I work with.

They get frustrated ’cause that’s how they were trained. They want to use the ultrasonic scaler. The Piezon, they wanna get in there and clean. But these sort of subset of patients. They just don’t like it. They come from a generation of being used to hand scales like 30 years ago and they want that again. So it was like a penny drop moment for me when I thought, okay, so actually what Wyman Chan is showing on the website for Magic three is that it’s good for nervous patients who don’t want that feeling of having a scale.

It’s good for children ’cause you can actually use it on age six and above ’cause it’s a class one medical. You can use it for anyone who just doesn’t like the feeling of the scaler. I personally don’t even like the feeling of the ultrasonic scaler. And you can use it on orthodontic patients in the prevention of white spot lesions.

So any orthodontic practice, any hygienist working orthodontic practice, this is something really worth paying attention to. Because to me it becomes like a kind of business model and a model of how you work your practice. A practice philosophy. So for example, I’ve worked in clinics that have adopted the EMS airflow model.

So every hygiene chair has got this EMS airflow, and they all get airflow as a set protocol that you do. You disclose the teeth and then you blast it all the away. And a lot of patients like it, some don’t. But the whole experience of the airflow, a lot of patients end up loving. Now, of course, there’s upsides and downsides to that.

Quite often the machine can, quite often I’ve seen on the WhatsApp groups that the machine’s having issues, they have to repair it and service it, and not all patients like it. So you have to go back to your usual hand scaling. But I think the practice where I work at the moment in reading, which I’m about to leave unfortunately, but I think that would actually work really well.

So this magic three treatment would be incorporated as part of the hygiene is what I’m thinking. And all patients would have it. And the way you do it, you apply it on the teeth, there’s a special retractor they put on, and like one dose is applied to all the teeth surfaces, all the gingiva, and it’s left for like 10 minutes and the patient wears a mask over it.

So this patient is just relaxing. There’s no discomfort, there’s no pain, there’s no scaling. And then once it’s rinsed away, all the superficial stains have gone. The teeth feel silky and super clean. These are the patient’s own words and any soft calculus has actually become even softer. So it’s really easy just to pick away the scaler and any plaque is gone, any gingival inflammation is starting to settle already.

So I was quite amazed talking about this. So we are recording another episode, just all about that and that’ll be a video only episode. Wyman Chan is literally launching this product tomorrow at the Dentistry show. So if you’re listening on the published day, then literally tomorrow this product is being launched.

If you want to learn more, including a special discount just for Protrusive members only if you think that your practice hygiene model would benefit from this or as a certain subset of like nervous patients or children that you see that would benefit from this, then head ever to protrusive.co.uk/magic3.

That’s protrusive.co.uk/magic3. And all the coupon code and discount details as they change month to month will be on there. Now let’s join the main episode. I’ll catch you in the outro.

Main Episode:
Dr. Wyman Chan, welcome to the Protrusive Dental Podcast, Niki Shah. 

[Wyman]
Oh, thank you, Jaz.

[Jaz]
Thanks for joining us, guys. 

[Wyman]
Well, thank you for inviting me. I’m really honored to be here. Hopefully we can share some of my work I’ve done with you guys with your community. 

[Jaz]
I’m actually really starstruck, right? Because, so the first time I ever heard about you, I was a dentist student, was at that conference, and a dentist I really respect, called Zaki Kanaan, was doing a demo for whitening.

And then he was mentioning your work and I got like a, I probably Googled you at that point. I was like, wow. He’s like doing whitening for all these celebrities. Okay. And so that was like, that was an amazing thing to see. And then, you know what he told me about this technique, which apparently no one else can do.

‘Cause you owned it apparently. And then we had to ask permission for you. So maybe this is myth busting or not. Okay. But essentially when you’re doing whitening to get super sealed tray, you score using the ultrasonic around the gingival margin on the models when we’re using the stone models.

Right? And then you make the tray on that and it has an extra seal then is that true that, that was stemmed from you and then someone had to ask like you had, like you own the patent for it or how does that work? 

[Wyman]
I own two patents in the UK. Just for the trays. Just for the tray design. Just that was a part of that. We have a seal. And we score the models. Not with the ultrasonic scaler with something else, but you can do that with a ultrasonic scaler as well. We use the tools, which is very how we say it is fun.

And I like to share this, whoever use my design, please use them. But just say that, who is the inventor? I’m more than happy to share. So, I’m very, very happy that Zaki actually shares my invention. Please tell- 

[Jaz]
But he did credit, he said that you, to ask and credit. So that was very good of him to do that. So he did in the proper channels. Shout out to Zaki. 

[Wyman]
But the trays are really amazing. I wish you, you guys just use them. Use them there. It’s free. Please use. 

[Jaz]
Okay. Super. Well, let’s just for those people who may not have heard of you, right. I just found out a few moments ago in the preamble that actually Dr. Chan, Niki, did you, I mean, you probably knew this already, but he hasn’t done actually dentistry for many years. He’s just been like, some people will only do dentures. Some people will niche into implants.

Very rare you find someone niches into teeth whitening. So we need to figure out what’s the origins of that. So, tell us about your story origin and then I think I’ll ask about you as well. 

[Wyman]
I hang up my drills in year 2002. That is over 23 years ago because at that time, in 2002, I opened dedicated to whitening clinic in central London. And I was very focused. At that time I encountered lots of difficulties and a lots of problems. Really lots of problems. 

[Jaz]
I mean, at that time, correct me if I’m wrong, at that time, technically teeth whitening was a deal. 

[Wyman]
Technically it was illegal technically whatever you do, it was illegal. Yeah, so we were all doing something illegal, especially me. I have a dedicated white in center, was really, really high, high profile. I was really, it is really good that the police never locked it my door. So I was really, really grateful. But until 2012 it become legal, it was good. So why did I hang up my drills?

Because when I was opening the center, I was really love teeth whitening. I thought that it was such a easy way, I would say to work is stress free if you do it properly and if you do it properly, there’s no complaint. And the procedure is so simple, really simple. I mean, they’re much easier than doing any form of dentistry, easier than scan polish, in my opinion.

But I encountered so many problems that our colleagues encounter now. So I use all the system, probably available at that time. And then I went back to the distributor and sometime I wanted to show, I asked the manufacturer, I say, I encountered this problem, that problem. They always come back to me, we never heard of these problems before.

Must be you. And then I started forming a group with like-minded dentist who are really interested in teeth whitening as well. And we found that they, we all facing the same problems. That’s the denial among the manufacturers. So I have nowhere to turn to, and that’s why I say that, okay, I’m gonna hang up my, my drills, I’m going to do research.

That’s when I’m starting research and progressed to that. Actually, in order to solve the problems, I went on to do a PhD and I got my PhD. The title is Safety and Efficacy of Teeth Whitening Processes. 

[Jaz]
Probably like we all reference it without knowing one of those things.

[Wyman]
Yeah. Because I encountered so many problems. So I was so lucky that in my years of research and studying my PhD. 

[Jaz]
Where did you do that? Which institution? 

[Wyman]
I did that at Bolton University. Which is the like a chemistry. Mainly I do a lot of chemistries. It’s in the institutes of material science and innovation.

What a place to do it. So lots of material science and lots of innovation as well. So I did five years in Bolton, but before that I was doing a lot of research because I encountered so many problems that I could not solve because I committed to open a show.

[Jaz]
If you can spend five years in Bolton, there’s no problem you can’t solve.

[Wyman]
Yes. No, we’ve very lucky. I’ve got a good team, good supervisors. Good chemistry. So we solve a lot of problems, so I’m happy. I’m here to share with you my journey in the last 23 years, 25 years. 

[Jaz]
There’s no question that you haven’t encountered. And so we guys, we got like a gazillion questions from you guys, the community. You guys been voice noting me. You guys have been screenshotting me. You guys have been telling me on Instagram, on Protrusive Guidance. And Niki, you are the man who made it happen. Thanks for connecting us. Hold back and just tell us about yourself. 

[Niki]
Okay, so, I graduated in 2011 from Barts in the London, actually with Dr. Sunny. Dr. Sunny and me are very, very good friends. And our stories are a little bit similar, so if people have heard, we went through the same process of hating dentistry so much, got seven, eight years in and realized what are we gonna do? We can’t become a bank or something, now we’ve gotta do something in dentistry.

That was in 2019 and I was really struggling with composite dentistry at the time. So it was been almost two years since I saw Dr. Sunny went to his house and we were talking, and at that time we were listening to Dental Town Podcast, Dr. Howard Farran. And there was one particular podcast by Dr. Dennis Brown in there and the Greater Curve, the famous Dr. Brown, famous Dr. Brown.

And we just decided, we’ve got together. We said, listen, we are struggling to get good composite, you know, restorations. Let’s just approach the team and see if we can get it into the UK and if they’re interested, we can actually teach dentists on how to use the system ’cause it’s completely different.

So we did that in 2020. The pandemic hit that actually gave us a little bit of time to step back and actually work on the business. And to Sunny is taking DRE from strength to strength. My focus was a lot on clear aligners at the time there. So my sort of what my character is like, if I feel that there’s a problem in something, I try to approach who I feel is the best in the industry to solve my problems.

So with aligners, I’d actually done the six months smiles course there. They were great. But I didn’t do many cases, as we were sort of going with Sunny and [inaudible] at the time. There I got introduced to two brothers from Australia, Stuart and Richard Whiteley, who developed a company called Proligner.

Very simple aligner company. Used the best two materials. Zendura Reflex and PET-G, had a seven-day turnaround time. And they have a pay as you go payment plan. So if you’ve got simple cases, 30 pounds in the aligner, 85 pounds for treatment plans. My profitability went up. So from there I started teaching and mentoring other dentists in clear aligners.

I’m nowhere near an expert. I’m not a specialist, just a humble general dentist. Over the past eight years doing clear aligners, I started finding a lot of my patients after I finished clear aligner treatments, wanted teeth whitening. 

[Jaz]
I mean something that you just, like throw in there like, oh, you got whitening included.

[Niki]
Absolutely. It was just a free thing. Oh, here’s some polo whitening. Take it with you. Do it for the next two weeks. There, I really didn’t know what I was doing. This last year I spent quite a lot of time in Malaysia, where my wife is from, and one evening I was sitting there and I happened to see a live demonstration of Dr. Wyman Chan doing something where they were prophylactically cleaning teeth using a gel.

It caught my eye and the kind of person I am, I have to find out more. So then I actually messaged Dr. Wyman Chan’s team on Facebook to say that I’m really interested in what Dr. Wyman Chan has been doing in Dubai and China.

Would there be any possibility that I may be able to be in contact with him? I’m currently in Malaysia. And one of your colleagues actually mentioned that, oh, Dr. Chan is from Malaysia himself as well, and luckily put me in contact with Dr. Chan and I got back from Malaysia about six weeks ago and met up with Dr. Chan and here we are today.

So that’s been my journey, sort of my family background is products and business, so it’s kind of like I like to find products, bring them into the UK and then form sort of company around it. 

[Jaz]
Perfect. Well, Niki, thanks so much for connecting us and so very nicely from that products, right? Let’s talk about products, because the one question we have in the community, Wyman, I’m sure you get this all the time, right? It’s a bit like when a pharmacist gets asked, is there a difference between Ibuprofen two milligrams versus Nurofen,, the branded one, right?

So in a similar vein, my question to you is there are a gazillion brands of whitening. I once heard a rumor that all the gel is made in one factory in China. And then it either gets in this brand A brand B, brand C. Okay. Like a lot of products are. To what degree is that true? And to what degree does the brand matter more than the fact that it’s just hydrogen peroxide or just carbamide peroxide? Is the brand actually make a difference? 

[Wyman]
See, teeth whitening, it’s very special. To me, it’s very special. It’s not just the products. It’s not just the brand. It’s the combination of the brand of products and the technique. Protocols most important is a technique and a protocol. And the training, because we’re not taught teeth whitening and undergraduate school. So we go up there like a jungle, which is- 

[Jaz]
Wild west. 

[Wyman]
Yeah. Wild west. We try this product, these products. I’d like to give you a example for, to answer your question. I love red wine. Red wine, they are red in color. They all for 12.5% to 30% alcohol. They produce on many different countries.

Some wine is only two pounds a bottle, some can be 20,000 pounds of bottle. Is there any difference in the wine? It depends on who’s using it, who’s drinking the wine. To an average person, there’s absolutely no difference because firstly, there’s no training. They don’t know what difference, what to look for. Number one is- 

[Jaz]
How to taste it. 

[Wyman]
How to taste it. I mean the teeth whitening as well. What to look for, what kind of things to look out for. So that is one thing that we not touch. Similar in drinking wine. If nobody is, you haven’t been to any wine course courses to learn how to taste the wine, how to appreciate the wine, how the wine is made.

And it’s very different. That’s why the French call it ‘terroir’. It’s what is in the ground, what is in the soil. So it’s the teeth whitening as well. It can be, let’s say 16%  carbamide peroxide, there’s so many ways to make 16%  carbamide peroxide, so many ways and so many ways to apply them. And so many ways, like we can do it many, many different systems as well. So are they the same? Are they not the same? The chemical is the same. But the way to make it could be very different. 

[Jaz]
So really, if that’s the case, then yes. Where it’s manufactured, how it’s manufactured, how it retains its freshness, and therefore I’m hearing that the brand actually does matter. But here’s the problem is that, as dentists, we see who is the best marketer, right? We don’t see who has the best manufacturing protocol. Whose gel is the freshest, we go by ads and conferences and who is in our face and who gives us the first three or five cases.

So I’m gonna ask you very bluntly, in the UK and or in the US and around the world, for all our listeners in Australia around the world, which is the best brand? 

[Wyman]
There’s no ‘best’ brand. Yeah, no. Including mine. There’s no best brand. I think we as a dentist is that, let go back to the wine again. Why some people are so good. This connoisseur is all about practice. They drink it a lot. They have to keep on tasting it. This is called clinical experience. The same with teeth whitening. If you just do one a month, which is average in the world, average, if you do one a month, you’re on average. If you do two a month, you’re doing a lot.

You’re doing that double. So it’s average one. I mean, one, it should go back to the password. If you use your password once a month, you’ll forget it. The same with teeth whitening. It’s just forget all the protocol. You may have to look at instruction. 

[Jaz]
The nuances. 

[Wyman]
Yeah. And then you can start over again. It’s all about practice. The more you do, the better you are. I have done 20,000 teeth whitening case myself. At the heights I was doing like 50 a week, 200 a month. Do a lot. 

[Jaz]
And these were high profile people. I mean, I’ve seen photos of all the celebrities at your clinic and stuff, and these were not like I mean, everyone’s important, but like you are seeing the people who are like gonna be on tele or gonna be in a concert the next day. Right? 

[Wyman]
Yeah. I treat everybody the same. It doesn’t matter. 

[Jaz]
Yeah, of course. 

[Wyman]
Who they are. They come in, they’re all patients of mine. So I treat them exactly the same. My protocol exactly the same. My man is exactly the same. So I charge them exactly the same. So I don’t charge people reach you more money, it could be transparent.

So it’s all down to clinical experience. The more you do it, I don’t think it matter what you do, what which brand you use. The more you use it, the better you’re gonna get out of the brand. It’s just like the wine the more you’re gonna get out of, then you get to know, the more you taste, then you know which one you like.

Which brand you like, like which shuttle of wine that you like. It’s all down to experience. You have to do a lot, a lot of that to find out. Unfortunately I would say 99.99% of us not doing enough to find out. So we will never find out. 

[Jaz]
Okay. Well that’s interesting ’cause people are always on our brands, but the protocol, how you apply and the experience. So when it comes to occlusion, I talk about the Pareto’s principle of occlusion. What’s the 20% of things we do in the occlusion world that have the 80% of the result? Right? So if we talk about, if I was to ask you what are three things that are so, so important, ’cause I’m sure there’s hundreds, but which are the three most important things in the protocol that will yield the average dentist higher than, better than average results?

Because they did these three things well. Can you give us a flavor of what those three things would be if you had to, like of all the a hundred things, including the brand, including maybe the trade design, including anything part of the lights, no lights, what is the three most important features in getting a good whitening result?

[Wyman]
Number one, which is obvious that because 99.9% of the dentists in the world doing teeth whitening, home whitening, I’m talking about are using bleaching trays. So the bleaching trays got to be amazingly well made and have to be made properly. So please use my trays. It’s free. This is number one. 

[Jaz]
Okay. 

[Wyman]
I know that a lots of dentists, because we have a lab called Perfect trays, do a bit of advertising here. We make trayss for 5,000 dentists in this country, but only 20% of the dentists are using my job. And they’re using other job. They’re very happy. They must be very happy. So as the dental professionals, I always advise my colleagues, always do something that works with you. Work on your hands, don’t change.

If you’re happy with something, don’t change. Why get outside your comfort zone? Unless you want to experiment. So I see there 80% of the dentists using my design trays with other whitening brands and they have no complaints. Keep on sending the trays to us. So they must be doing something right. So number one is trays, really. 

[Jaz]
So can we expand on that then? Okay. So I mean that was one of the other questions. The trays. So maybe we’ll come back to it ’cause I don’t wanna distract you from the three points, but dentists would like to know. What is the the ESSIX retainer style trays?

Harder, softer or reservoir? No reservoir. These are some of the bank of questions that everyone sent in, but number one, tray design number two? 

[Wyman]
Number two, you got to choose what kind of bleach you’re going to use. There are many, many different bleach around. You have carbamide peroxideite base and you have hydrogen peroxide base, and then you go to -, I’ve been doing teeth whitening for so long that we have to offer a regime to our patients that they can do it.

It’s no point prescribed something that they can’t do it. So we spend time. I think the time is really important. Communication is really important. We need to communicate and find out from our patients. And can you do it? Can you wear the trays overnight? If you can’t, then can you do it in the daytime?

If you can’t do it in the daytime, then, what else can we do? So we’re gonna find out that prescribe something to the patients that they can carry out. There’s no point prescribe something to the patient that they cannot do. Totally a waste of time with somebody. Money and you won’t get results because the patient’s not going to do it. Number two is communication. Find out the needs. How to do it. I think that is important- 

[Jaz]
And like making it practical for them. Practical, pragmatic for them. For example- 

[Wyman]
Easy user framing. 

[Jaz]
Yeah. So for example, 99.9% of my aligner cases, if we’re doing any whitening in aligners, like as we get an advantage towards the end, it just makes sense ’cause they’re wearing the aligner at the overnight anyway to wear at night because it’s annoying for them to now take off the aligner one more time.

Additional to eating and stuff to do that. And that works for my patients because they’re more likely to comply. Their compliance is good. That’s an example. Now, for the baby dentist, for the younger colleagues, maybe dental students listening, watching. And I’ll say, I’m not saying this as an expert, I’m saying it, I’ll say it, and then you correct me if I’m wrong.

Hydrogen peroxide breaks down about half an hour to an hour, and then that’s how long you use it for. Carbamide peroxide up to five hours. Therefore, we use carbamide peroxide, slower release at nighttime and hydrogen peroxide for that kind of power hour during the day. Anything you wanna add to that and correct me?

[Wyman]
No, you are correct and that’s where we come to point number three. 

[Jaz]
Ah, okay. Nice. Okay. 

[Wyman]
It’s based on the the bleaching time, the contact time. I advocate, actually a coin of a phrase called conscious bleaching against unconscious bleaching, because a lot of us are giving them 10% carbamide peroxide my peroxide, which is supposed to be the gold standard according to the ADA, American Dental Association. It been there for so many years. I think it should be upgraded. And a lot of people are using 16% carbamide peroxideide peroxide, which is equivalent to 6% hydrogen peroxide. The maximum strength we can use in the UK.

I like conscious bleaching because if it hurts you, you know, somebody pinch you, you know it hurts. Like if you are unconscious doing at night, you are forced your fine asleep, you’re gonna have the pain the next day. And then you talk about over bleaching and that is very painful.

So I prefer daytime bleaching, which the patient in control. If the patient feel anything that is not right. For example, certain tinge on the nerve, you know that is all bleach, you stop straight over, take a trays out, wash off, that’s it. You won’t have anymore pain. So it’s conscious bleaching. 

[Jaz]
Okay. Perfect. So number one, trade design. Number two, make it pragmatic for the patient and that involves communication. And number three is conscious leading. I’ve never heard of that. I’ve heard of- 

[Wyman]
Conscious bleaching. 

[Jaz]
But now we have conscious bleeding. 

[Wyman]
Not unconscious. 

[Jaz]
Has to be conscious. Okay, great. Niki, anything from you before I carry on with more questions? 

[Niki]
No, it’s just mainly the thing was again with the different gels that you have. Dr. Chan, I think one thing, that you forgot to probably mention was the fact that you’ve got a dual barrel action. So the gel is only activated once you push it through the plunger. So I mean, Dr. Chan probably will explain that his gels have a patented activator in them. Double barreled. So it’s only activated once you push it through. 

[Jaz]
Okay. It’s like a metal primer with the A and B bottle that only gets. 

[Niki]
Yes. 

[Jaz]
Okay. Interesting. I didn’t know that. 

[Niki]
And I thought that. So I’ve used Dr. Chan’s gels. I’ve only been in contact with Dr. Chan for two months. I’ve done five patients using hydrogen peroxide, daytime bleaching, and for the first time I have had zero sensitivity. I actually asked them, I want to know even if you feel a twinge at any time. Zero. Nothing. So, one of the main reasons Dr. Chan is so popular is because he does tooth whitening painless. 

[Jaz]
So that’s the second patent then is it? That gel activator, is that the second you had the first patient trade on? 

[Niki]
No, in fact, I have 15 patents. 

[Jaz]
Okay. All whining related? 

[Niki]
Whitening and some other things. 

[Jaz]
Love it. Okay. 

[Niki]
So mainly need them in dentistry.

[Jaz]
Okay, great. Well, on the topic of sensitivity then, right, well, I’ve got a couple of questions. One, you talk about concentration percentage. Let’s just tackle that first before we go to the big one, which is sensitivity. Let’s say you are anywhere in the world, doesn’t have to be UK. Because obviously we, in the UK, we have the issue of the maximum concentration being 6% hydrogen peroxide, or as they say, 16 but technically is it 18%? Because if they- 

[Wyman]
16.67. 

[Jaz]
Love it. Okay. 16 and two third percent. carbamide peroxideide peroxide, it breaks down into 6% hydrogen peroxide and urea and water. 

[Wyman]
Urea and water. 

[Jaz]
Okay, good. 

[Wyman]
Oh, no. Urea and hydrogen peroxide. carbamide peroxide micro peroxide. 

[Jaz]
Oh yes, yes. Fine. 

[Wyman]
Urea and hydrogen peroxide.

[Jaz]
That’s the one. Okay, fine. So, but we do that ’cause we’re here and there’s these rules. But when you do whitening other parts, well, you had free rain and you had to make the rules again, would you keep the existing rules or would you change it because you feel in that conscious whitening for that one hour a day, you would want the patient to have a higher concentration of gel?

[Wyman]
I would like to have a high concentration of gel because I’m an inventor. I invented all the gel myself, the formula. ‘Cause I’ve spent a lot of time doing in research, I have many different type concentrations carbamide peroxide, my peroxide, hydrogen peroxide, the best gel, the really best gel. I mean, it’s so magical. It’s 10% hydrogen peroxide. Unfortunately, we cannot use it in the UK. That’s why the reason I left UK because of that. 

[Jaz]
Wow. 

[Wyman]
I was so upset and so disappointed. I cannot use my best invention, so I have to take it somewhere else. And then someone, and unless someone else can use my best invention. 

[Jaz]
I can totally relate to that. Because if tomorrow, they said in the UK we’re not allowed this specific type of rubber dam that I like, I would move country as well.

[Wyman]
We all have something. Right? 

[Jaz]
What’s yours Niki? What is it that they removed it tomorrow you would move country for? 

[Niki]
Well, what would I remove move country for? It’d be something sports related. Definitely. It has something to do with cricket. If they got rid of something that from, or TV or something, I’ll be gone.

[Jaz]
Okay. So, that answers that 10% hydrogen peroxide. You are the expert, we’ll take your word for it, but sensitivity, that’s one thing that I’m sure 80% of the questions asked you are regarding this. It’s the number one complication for teeth whitening. And so what should we know?

You have the floor everyone’s really interested in your expert advice here. How can we ensure that our patients have their teeth whining as comfortable as possible? Because if it’s comfortable, the compliance will be better. The results will therefore be better. And they won’t be like, what we do as colleagues is, oh, if you get sensitive, do one day on, one day off, or rub this toothpaste in.

And all sorts of advice we give. I don’t know which of these advice is appropriate. Because you just said sensitivity wasn’t happening in your patients. Maybe you’ll tell me that since if the patients are feeling sensitivity, then maybe what we’re doing is actually wrong. Maybe you’re saying zero sensitivity.

I would be surprised if you say that, but maybe that is the proper way. So I’m actually genuinely interested. Sensitivity. I want your take on it. 

[Wyman]
It can be zero sensitivity, but it need a lot of experience. But to make it minimal, really the sensitivity. Sensitivity, so minimal, let’s go back to the three things. Number one is the tray design really important. The tray design. You see my tray design with a little dimple. That is really, you only need a tiny bit of gel. That’s all you need. 

[Jaz]
So they’re called like dosing dots or reservoirs also same things, right? 

[Wyman]
Same thing. My invention. Everybody copies it. Good luck. I don’t mind. I like to share. Just create Dr. Chan in the future. 

[Jaz]
Yes, of course. Absolutely. You had it here first, guys, if you’re doing these dosing dots, you have this man here, the hank.

[Wyman]
And also the seal as well. You score the model or all those helps this the moment. 

[Jaz]
And then people market it as super seal and all these kind of things. Why don’t you sue all these guys? 

[Wyman]
Now why not you sue? I want to share. 

[Jaz]
Good. I knew you’d say that. That’s why- 

[Wyman]
I wanna get out. In fact, another company asked me to sue another company. I said, why would I want to do that? I want to share. I say, I would like it because you stole it initially.

And then I never complaint. And then you stop using it. Now someone is using it. So I say, I don’t complain anymore. Everyone is using it. What’s the point of complaining? So just use it. It’s wonderful. Number one is the trays really important. Number two, conscious bleaching. Because if you wear the trays, go to sleep, you asleep, it hurts you, already in your sleep.

By the time you wake up, it’s too late. It’s painful. Because what it hurts is over bleaching. It’s a gel as a peroxide got to the pulp and cause pulpal inflammation. 

[Jaz]
Doesn’t that happen anyway? Isn’t that supposed to happen in about 15 minutes, the gel will reach the pulp.

[Wyman]
Well, it depends how much pulpal inflammation you’re gonna have. If you do conscious bleaching, you know it straight away because you feel it, then you stop, you remove everything. You just stop and rinse your mouth out. If you are asleep, you don’t know what’s going on. It’s been hurting your pulp for so long, maybe four hours. Maybe six hours. 

[Jaz]
So what you’re suggesting is- 

[Wyman]
Conscious bleaching. 

[Jaz]
With conscious bleaching, if someone’s doing it during the day and 20 minutes later they start to feel something, take it out. Take it out. And then that’s day one done of whitening. Is that what you mean?

[Wyman]
So the next day do 18 minutes.

[Jaz]
Okay, perfect. 

[Wyman]
Yeah, because it hurts you at 20 minutes. You do less than 20 minutes. 

[Jaz]
This is great because, you read the packet, it says half an hour to an hour it, and then that’s what you give to everyone. 

[Wyman]
No, it hurts. That means the bleaches got to the pulp. That’s why it hurts. that’s like a simple, it’s all about diffusion.

Not too much signs, a little bit of signs diffusion. If you paint the gel on the teeth on the surface of the teeth, it takes time to diffuse all the way through the enamel to the dentine and get to the pulp. It will get to the pulp. A little bit get to the pulp, it not gonna hurt you. A lot of the bleach get to the pulp is gonna hurt and very painful.

That’s why I’m an advocate of conscious bleaching. Do it consciously. When it hurts, you take it out straight away and look at, oh, I’ve done it for 30 minutes, so next time I can guarantee you do it for 29 and a half. It will not hurt you. Except just a little bit it get to the part where it hurts.

So you can adjust your time. So if it doesn’t hurt you the next day, it can increase a little bit more time, you get a better result. So you just play with the time to the dentist. That’s why I advise my patients. We want you to be safe. Start with a short time, maybe 15 minutes. It doesn’t hurt you the next few days. Going to 20 the next few days, 25, 30. 

[Jaz]
Just progressive. 

[Wyman]
Yeah. Just use highest constriction you have. Why use 3%? Why use, if you can use the 6%. It’s the same price. I couldn’t understand why dentists buying 10% instead of the 16% carbamide peroxide by, or hydrogen peroxide. 6% instead of 3%. You pay the same price. Why not get to 6%? 

[Jaz]
Okay. And this modify the time. 

[Wyman]
Modify the time. You get a much better result. 

[Jaz]
Okay. That makes sense. But here’s the thing, right? So let’s say I put my whitening jar on, like, I’ve whitened before and then, get sensitivity. So are you saying that I’ve over bleached? 

[Wyman]
Over bleached. Yes. 

[Jaz]
So even the next, like that evening, let’s say I whitened during the day that evening, I drink some cold water. I feel it in my tooth. Like hours data is because I over bleached? 

[Wyman]
Yes. Over bleach. Yes. 

[Jaz]
Okay. 

[Wyman]
This is powerful inflammation. Well it’s different from dentine hypersensitivity. Totally different. 

[Jaz]
And then so over bleaching is, the formula of over bleaching is time too much time, potentially too much concentration. Okay. If you’ve done that. Oh, sorry, I remembered my trail of thought now. So what are the dental features that you can look at and you’re gonna warn that patient extra. For example, if the patient’s got deep caries, I would say to them, look, I’m warning you that you may need a root canal because you have deep caries. Whereas I wouldn’t really emphasize so much if they had a small caries lesion.

When it comes to the whitening. What are the features that you are looking for? Thin enamel, for example, or micro cracks in teeth, for example. Are these all things that you may say to a patient actually because of these features that you present with, your bleaching time will be less. Can you give us some, shed some light on that? 

[Wyman]
Yeah. I think the anatomy of the tooth is very, very important. And the amount of enamel, over the dentine is important. If we have abrasion cavity at the cervical margin exposed dentine , if you put gel in those area, it can get to the pulp in no time because dentine a lot more power than enamel.

It just goes straight to the pulp and it hurts within a minute or two. So we avoid applying gel on the exposed the dentine, or maybe best just to seal the tubules, open tubules or expose dentine first before using, using some GI That’s, I normally do. You don’t have to do like- 

[Jaz]
Class five restoration with GI Yeah.

[Wyman]
Just not to fill it, just a thin layer. Just to block the tubules. 

[Jaz]
Okay. 

[Wyman]
So and then you can apply gel over because you can do it by accident. So if you put on enamel, usually, the pain is not there. Enamel is very thick and very, very dense. If the patient may feel sensitivity, if you do, it just will always advocate conscious bleaching.

If you do consciously, the patient will know, oh, I’ll do it for less time. It’s only once they fill it. And it’s not painful. It’s only a tiny pinch, not painful. Okay. If you do it overnight can be very painful because you’ve been over bleach for so long that you do not know, because you fall asleep.

You do not know. Because the pain is very mild. And only get stronger and stronger as the inflammation in the pulp is nowhere to go expand. That’s where they get really painful. 

[Jaz]
Why is it that, I have some patients and their teeth look virtually the same to me. Like it’s very similar, but one will come back saying, she’s had an absolute nightmare.

Like the teeth are way too sensitive. And let’s say they both did it for one hour or half an hour and there’s, yes. Let’s say we’re over bleaching for one person, obviously, ’cause they’re getting sensitivity, but the other person comes back saying, is this even working? Well, my teeth are whiter, but you warned me so much Jaz, but I’m not getting in sensitivity.

Do we understand the pathophysiology of it to a degree of why is it that some people will get it more than others when they might, it’s not obvious exposed dentine or those factors. 

[Wyman]
Yes. In fact this was my PhD thesis. Probably you read my thesis somewhere. Yes, it is. It depends on the porosity, the density of enamel. Because we cannot tell, I devise a way that we can tell the porosity and the density. That’s what I taught now in China, I used to teach this here, must be over 5,000 dentists probably everyone forgotten what and touched them. So hopefully go back to the notes.

I get them notes. It’s just look at the porosity and the density. The process is very simple. So I don’t wanna go into that today. 

[Jaz]
Sure. 

[Wyman]
Because I trust for that course. 

[Jaz]
Sure. No, appreciate that.

[Wyman]
I think it can easily distinguish. 

[Jaz]
Okay, fine. So the porosity, something, you when we’re looking at our eyes, they look the same. But your porosity is once you discover the prosti is you can predict. 

[Wyman]
That’s right. You could to do some, I would say that’s, just do a little bit of work to find out. Okay. Little bit what to find out. It’s very, very easy. I touched that many, many years ago here. 

[Jaz]
And patients, do you recommend any special toothpaste or desensitizing agents for your patients?

[Wyman]
I never use that. 

[Jaz]
Wow. 

[Wyman]
Never use that. I never use desensitizer. I never use any, because if you do conscious bleaching, you don’t need them. You’ll need them when you do unconscious bleaching, please do your bleaching consciously from now on. It’s the same thing.

[Jaz]
Because that was like a huge question. The community is, okay, which products, which desensitizing agents I use? Should I use pro relief? Should I use this one? Whatever. 

[Wyman]
I don’t use any. 

[Jaz]
I love that. Excellent. Well, I’m gonna take a moment to- 

[Niki]
Sorry, can I just say one thing? I mean, a funny thing is like when Dr. Chan is the first person who introduced me to treatment planning for whitening. According to me, whitening was simply taking impressions on people who wanted whitening, get the trays made, giving them the bleach. Hope I see you in three weeks in the teeth. That what Dr. Chen runs a treatment planning surface for whitening cases. And how many cases is it that you’ve done now in China, Dr. Chan, that you’ve- 

[Wyman]
About 10,000 cases. It’s a slightly mis line. A treatment plan? Yeah. In China. 

[Jaz]
And there is a plan because there’s a sequence and you every case is different and there’s a protocols. 

[Wyman]
Every case is different. And then we refine them. Like aligners. If something’s going right, we refine them, as we go along. So there’s lots of refinements. 

[Niki]
It was just wonderful concept that treatment planning and whitening. So, I’ve seen pictures from dentists coming from China where Dr. Chan will tell them step by step, okay, you need to use 6% there. Okay, we need to calm down in this area. Use 8% here. It’s amazing. Amazing. Something I’ve never thought was even something that we didn’t.

[Jaz]
I think it’s great you mentioned that, Niki, because I remember being a foundation dentist and I was telling, ’cause you’re right, we at undergraduate level, we don’t get taught whitening.

So I remember going to my foundation trainer, like one or two months into it saying, look, I need, I think I need to go to the whitening course. Do you think I should go? And this was a bit when you left the UK. Yeah. So, this is when he left the UK and he laughed at me. He says, it’s just whitening.

He’s like, just make some crazy and get some gel in there. Like, so there’s a culture, there’s a thing that is easy, but actually there’s so many nuances, right? There’s so many nuances. And you’re right about the treatment planning. Uh, I’ve got, because we got how much- 

[Wyman]
Can I add onto to your- 

[Jaz]
Please.

[Wyman]
I think that is whole research looking at a porosity density. But everyday life, you don’t have to do that because it’s cumbersome. It takes a lot of time and a lot of chairside time to how I say, to assess the porosity density of enamel, but just use what I just said.

Conscious bleaching. That’s all you need. And the trays, that’s all you need. And then just adjust the time accordingly, because it’s really cumbersome. It’s not easy and you’ve got to be able to recognize it. And just like drinking wine again, you got to practice and practice and practice otherwise in front of your eyes. You can’t even know, you don’t know what you’re looking at. So stick- 

[Jaz]
I think if you drink enough wine, you won’t be able to see where it looks like. It’ll stick to something simple. 

[Wyman]
My trays and conscious bleaching, that’s it. And adjust the time accordingly. You can do it really very comfortable for your patients. And don’t go into too much the details, because that is complicated and take up a lots of chairside time. 

[Jaz]
I’m so excited to get this out to the community. By the way, this is already, so many gems in there. Dr. . Hello, Dr. Esther from Protrusive community. Is it true that patients should try a white diet when having treatment?

[Wyman]
I heard of that when I was started bleaching 30 years ago, after I done my PhD. It’s not necessary. I’m a coffee drinker. I’m a red wine drinker. Look at my teeth. Look at my teeth. They’re barely white, OM3. You don’t have to, if you notice signs I don’t want, let me go a little bit of into science then if you don’t mind.

When we bleach the tooth, make it white, it’s the color of the dentine that reflects through a translucent enamel that we see in the color of the tooth. And dentine is usually darker yellow in color. So to make the tooth white, you have to bleach the dentine whites.

Once you bleach the dentine white, doesn’t matter. Whatever you drink and eat. No. It doesn’t matter what you drink and eat. It’s absolutely, it’s actually no factual – what do you have to wait? Just wait for the pellicle layers to come back. Maybe take about five minutes. If you want to come back faster, have some chewing gummy coming in a minute. That’s it. You can have a cup of black coffee, a glass of red wine a minute after you do your bleaching. 

[Jaz]
Well, I’ve seen this advice about try a white diet. In like magazines and stuff, so it’s all BS. However, on courses for whitening or on aligner of courses where someone also wants to give some whitening advice, it has been said by educators that for two hours after whitening, avoid anything brown, avoid anything staining. Is that true or is that false? 

[Wyman]
Scientifically it doesn’t make sense. I can’t say it’s false or true, but some company actually advocate that two hours, no colored food and some company actually saying that for the whole cost of bleaching why you’re doing the bleaching you can only have white food.

[Jaz]
So what does Wyman Chan do? 

[Wyman]
No restriction. Zero. 

[Jaz]
I love it. 

[Wyman]
You can eat and drink whatever you want. No restriction. 

[Niki]
Just give it one minute. 

[Wyman]
I think I need to be safe, 10 minutes for the particular layer to form a thick layer on enamel. 

[Jaz]
Perfect. This is gonna be a tricky scenario that we face. Okay? So, non-vital teeth, let’s say you have like a single central, which is a bit more yellow or black. And I appreciate that. That’s a very significant detail. You can’t be blase about it ’cause the protocol will be different. But the crux of it is, this is from Ian. Thank you Dr. Humphreys for this question.

How best to proceed with non-vital whitening when the patient also wants the other teeth whitening. So, for example, when I have such cases, I’ve done it before where I get my target tooth whiter and maybe slightly whiter than the rest, and then I start the whitening all the others, whereas other people say, just do ’em all at once.

What in your experience works best as a rule of thumb? ‘Cause I appreciate that. Just like back to your point, Niki, that actually everything needs treat on planning. But to make it generic, is there a specific way that you recommend to approach this? 

[Wyman]
A single discolored tooth is discolored tooth and the less discolored tooth also discolored tooth. So, and normally I teach just do it at the same time. The more discolored tooth will whiten, will bleach faster. The whiter teeth will bleach slower. They’ll catch up. I haven’t seen a case that hasn’t catch up. I’ve done a lot of cases. They all, at the same time. They’re all external bleaching. I don’t do internal bleaching anymore. 

[Jaz]
Say that again in case someone missed it. 

[Wyman]
So I don’t do internal bleaching anymore. There’s no need for internal bleaching. This was the gem I was waiting for. 

[Jaz]
This is okay. This is pretty cool. Okay. As someone who has done, I’ve got some great photos. I can show you internal bleaching cases and I’m very proud of them ’cause you said show your bad case show good case. Now for the visual feature of this podcast, what we’ll do that. But I’m amazed. So we’ll save that for the visual podcast. So make sure you guys tune in to that one as well.

[Wyman]
I’ll send you some amazing cases.. 

[Jaz]
Yeah, without having to actually open up the access cavity again. That’s fascinating. Okay, cool. 

[Niki]
So, sorry. Where it becomes even more useful is, so where it becomes even more useful is your dark tooth that hasn’t had endo – 

[Jaz]
Metamorphosis. 

[Niki]
Yes. That’s where it becomes really useful, because an endo tooth already has a cavity at the back of the tooth there. So, I mean, walking bleach technique, you can do that. But there are dentists out there who are advocating for those dark teeth to do endo and then walking bleach technique. You don’t need to do that anymore.

[Wyman]
Now, I used to do internal bleaching. I’ve got very good result. I learned that, but then I started experimenting because it’s very technique sensitive doing internal bleaching, really technique sensitive and also taking up a lot of chair time- 

[Jaz]
But also it can be iatrogenic. ‘Cause every time you open up an as cavity, can you guarantee that you’re not removing some more dentine, some more enamel? You will be scratching a little bit. Absolutely right. 

[Wyman]
I’m not a restrictive dentist, so I’m just look at the bleaching side. But now I just offer another alternative way of bleaching that tooth.

I think we are so lucky to be a dentist. We can do certain things in so many ways. In many ways of doing certain things. So I just add another option to the dentist to choose. If they learn internal bleaching, please do them. 

[Jaz]
Well, it’s also something like for some reason, obviously we’re going talk about in the next episode, but for some reason they’re not getting the result that they usually get from when they do the access cavity, do the internal, they still have that option to go inside, but if you start outside, there’s more minimal. It just makes a lot of sense to me. 

[Wyman]
And it’s non-invasive. 

[Jaz]
Yeah. I mean, why not? I mean, with non-invasive and chair time. It makes sense. 

[Wyman]
Chair time is my, because I don’t have the drill anymore, I can’t do internal, my bleaching because I’m. This is just because I give myself restriction. I have no drills in my clinic. Absolutely. No drills. 

[Jaz]
There we are. 

[Wyman]
How can I do internal? 

[Jaz]
That’s the proof. This man doesn’t even own a handpiece. 

[Wyman]
I don’t have a handpiece. Fast, slow. I don’t have a handpiece. 

[Jaz]
Excellent. Peroxide allergy. Is it a real thing? And how common is it? 

[Wyman]
I came across that on a couple of my patients. They claim that they allergic to peroxide, so I send them to hospital and then they done a lot of tests. So, it happens to be the makeup. This was bought a week before. 

[Jaz]
So they, what? 

[Wyman]
It’s a makeup they bought a week. 

[Jaz]
It’s makeup. Okay. Cosmetic thing. Yeah. 

[Wyman]
I read a lot of literature. There’s no proof that peroxide give us an allergic reaction. The reason is that because peroxide is not a foreign substance. We produce it in our body. If allergic to peroxide will be in real trouble.

[Jaz]
Well, I have a patient who, she tried, we tried whitening for her. And then she’s starting to say her lips start to swell. Her lips were swelling. What do you think was going on there? 

[Wyman]
For example, if you use 16% carbamide peroxide, my peroxide, what’s the other 84%? 

[Jaz]
What’s the other 84%? Okay. So it’s not the peroxide, it’s what else is in that gel that’s causing it. Okay. Do we know of any common agent that- 

[Wyman]
No, we do not know because has no research is done in that field. But to come really to prove it’s allergic by peroxide, there’s none. The literature there, there are hundreds of thousands is none.

[Jaz]
Okay. So if that’s happening, maybe changing the brand of the whitening, maybe effects just, and also the hospital, the true test. Yeah. And ’cause we cosmetic- 

[Wyman]
Always send them to the hospital to do some testing with the product is what they can test it on. 

[Jaz]
Yeah. Okay. Perfect. 

[Niki]
It’s quite similar to sort of patients saying they’re allergic to adrenaline and the anesthetic there, but there are some patients who are adamant that they are allergic to adrenalin.

[Jaz]
That’s true. That’s a good point actually. Very similar. Okay. We have some questions about light, which I’ll come to. There’s also some questions about, yeah, more about sensitivity. Tetracycline staining. I have read some guidelines that it’s a three to six month worth of whitening treatment.

Is that something that is predictable? Is this something that you’ve treated before with success? And anything, any tips you want to give to dentists who want to not do veneers and crowns on these tetracycline stained teeth and they want to use whitening? 

[Wyman]
I think probably wait for the V show. If I ever saying anything now, you will not believe it. 

[Jaz]
Wow. Okay. So even more excitement for the visual episode. 

[Wyman]
Seeing is believing, I mean, tetracycline teeth, they’re just staying on the dentine mainly on the dentine. Because we take the tetracycline antibiotics into the bloodstream and get to then it get to the pulp and then it affects, when the dentine is forming it, it affects the dentine formation.

If we take it earlier, it can affect the enamel as well. So it depends on the age. It’s bleaching. It’s discolor tooth. If you got a good protocol, it works. Like I can show you some cases just two weeks. It’s amazing result we get from a C4 to B1 just two weeks.

[Jaz]
Two weeks for  tetracycline staining. 

[Wyman]
Yeah. And then we have amazing result four weeks. 

[Jaz]
Alright, let’s wait for the visual one guys. So you guys have to tune into that. That’s fantastic. 

[Niki]
Just one thing about  tetracycline staining.. ‘Cause I asked, first thing I asked Dr. Chan about sort of tough cases,  tetracycline staining,, but something Dr. Chan told me that’s very poignant. In 13 years, I’ve seen two tetracycline cases in my whole 13 years. This was a problem that was in the seventies and eighties and nineties when there was a lot of tetracycline antibiotics being taken and a massive problem in the far east.

So in China where Dr. Chan practices and teachers there. That’s still a massive problem, but that even then, because the younger generation now, they’ve not been exposed to tetracycline. So it’s a very rare thing that we are gonna get tetracycline staining, especially this side of the world. 

[Wyman]
Yeah. It’s very rare in the West now. It was, we started prescribing tetracycline in 1965. And then we stopped in 75 because we dentists discover a group of children got very discolored teeth. And banded as well. And then, we start the doctors, the GP started tracing back and everyone had  tetracycline. 

[Jaz]
One day it’ll be like in a textbook that there, the once upon time there was COVID, once upon a time there’s text cycling state. 

[Niki]
I was saying our kids are gonna learn about COVID and history books like we learned about the Cold War. 

[Jaz]
And we’ll learn about text cycling in the dental history books as well. Uh, okay. The last question I have then, before we then take a break and we pivot into the visual one, which I’m very excited for, especially the  tetracycline, is all to do with light. So when I qualify as a dentist, there was this various brands that had the lamp, that whether it was heat or whether it was light or photo initiated, all these things and then coinciding with a time where the legislation changed and now you can only use a certain percentage that almost vanished.

And so is like, what I’ve heard is that that light is a gimmick. What I’ve heard is that that light, the light is just marketing and there’s no science back. Even the warming is not so significant. So I guess what I wanna know is, do you you use photo initiation or light as part of your protocols?

[Wyman]
Are we talking about in office bleaching here? 

[Jaz]
Yes. 

[Wyman]
I don’t do in office. 

[Jaz]
Okay, so- 

[Wyman]
I don’t use light. 

[Jaz]
Is it in office, even like when you’re consulting dentist, you are giving ’em advice. Like they start a new clinic and they say to you, Hey, I wanna start offering whitening. Should I even include in office as a treatment modality? And sounds like you’re gonna say no, but why is that, why do you not offer it yourself? 

[Wyman]
I would say no, because it take up so much chair side time. It’s really not worth it. You’ve got to charge so much money for the chair side time. And it’s how much can you charge? So it’s not, not how we say it, it’s not profitable, it doesn’t make sense.

And it’s very technique sensitive. The sensitivity is from chair side. There’s a lot of things can happen at the chair side. I don’t wanna go into it. A lot of things can happen. The pain was created during the chair side treatment, not home. So avoid that. 

[Jaz]
It did make sense. And then therefore we don’t need those.

[Wyman]
You don’t need to do chair side. Especially, I’m so pleased with new regulations. We can also can use 6% so we can get rid of the chair side. We don’t need chair side. And it’s very, and those other countries can use 40%. It’s so risky. I mean, look at that. 

[Jaz]
I mean, in Singapore when I was there, we using high percentages.

[Wyman]
Look at the damage you done on those accidents. You really are talking about massive damage, burning gums. Burning lips. And the gums peel off. It’s not worth it. Just not worth it. 

[Jaz]
But then as part of your protocols, when they take the gel home and the tray in your trays is there, and I learned that yes, the gel’s very fresh ’cause it’s got the activator. But is any form of light therapy used in your whitening protocols? 

[Wyman]
No, we don’t use light. 

[Jaz]
Listen, if Wyman Chan’s not using light, do you need to use light, doctor? I want you to really look in the mirror and reflect on that point guys, for anyone who has any question about light. Okay. Because the man has spoken.

Now, before we wrap this up, I want to ask about, is it okay if ask about Magic 3? Is there something you want go into- 

[Wyman]
Of course. Yeah. 

[Jaz]
Right. So Niki’s showed me some images of inflammation or inflamed gums, abscesses managed using a gel formulation containing peroxide. And it was like, it looked amazing. Okay. And so you are the inventor of all this? 

[Wyman]
Yes, I’m inventor. Yes. 

[Jaz]
Tell me about like what the problem was that you faced that, what was the problem that you thought, okay, we need some sort of solution. What problem are you solving with this and where is the journey in this product development so far?

[Wyman]
Okay. I spent a lot of time in China. I’m working with one of the group practices, which is mainly an orthodontic base practices. And then, and they have about 25 clinics and they do a lots of clear aligners and some fixed as well, a lots of clear, they have very good, lots of ’em about my PhD and professors in Peking university.

And I worked with them and initially I didn’t see a lot of children. But then as we get closer, get a bit friendly with the orthodontist, and then they came to me say that and show me some cases and said they have this problem, which is the white patches and white patches.

And then they show me that the children, even though how well they would motivate them to do good oral hygiene and to success, can’t do it. Children are children. They just can’t manage the good oral hygiene as which we fix braces. And that’s when one of the professors, actually, when we’re talking, we spend lots of hours. Drinking and talking. 

[Jaz]
Red wine. 

[Wyman]
Red wine. Red wine, yeah. And we actually spend hours on what we can bring and what we can help the population. And then he come over, say, we’ve got all this problem with plaque control. He said, can you, say mechanical cleaning is difficult. Can you make something chemical so that to help them before hygiene.

So I say, oh, okay. Because I look at, because I’ve done a lots of work, I know plaque control. I look because those cases, especially when you see those cases, you don’t get results. There are lots of plaque on the teeth. The bleachers couldn’t get to the teeth. So these are the cases, you don’t get good results.

So that’s why I always very keen and plaque control, make sure the teeth that I’m gonna bleachers plaque free, if they pull a plaque, they’re not gonna work. Mm-hmm. They’re gonna-. The, peroxide. And it’s all wasted. And that’s when I started looking into it. And what I have, my formulation I have is all too strong, it burn gums, all those.

So I come up with Magic 3. Magic 3 is 3% hydrogen peroxide base. And I modified the formula. Then I got a, I actually make into a medical device, a Class one. So that everyone can use it and 18 can use it. 

[Jaz]
Under 18. 

[Wyman]
Because it’s a medical device. Class one, it’s registered and when I make this product, I send it to the MHRA. They say they have no such thing. So because I say this is a colorless plaque indicator, remove plaque at the same time also reduces gingival inflammation. They say, we have nothing like that. So they refer me to organization, so called GMDN to Global Medical Device Nomenclature.

So I went there, I joined the members. I say, I got these products. I want to register as a Class one, but the MHRA say, they haven’t got such products, said, no problem. We’re gonna look at it and we’re gonna give you a new number and then you apply. And we did.

It took us two months. We got, they actually make a new number for us. Yeah, so it’s brand new, it’s innovation. So we got a Class one in this country. I’ve got a Class one in China as well. So this is amazing. It’s a colorless plaque indicator. Have you heard of something so ridiculous before? 

[Jaz]
No. So the traditional case, bright pink, bright purple. 

[Wyman]
Exactly. So you see, the way I look at it is that it’s not only indicate plaque colorless and it’s also rainbow plaque at the same time. So the reason I brought this up, I thought about it for, for about a couple years to bring this up.

So I look at the traditional plaque indicator. They are colored and the mixtures of this closing material with the plaque or bacteria or the plaque itself. And produce color. And then we have to use mechanical means to remove them.

To me, I think you give them poison and then you get them antidote. That’s not, see, and that’s why we do not, I mean, how can we trust patient by discolor the teeth and then will remove the color and charge them? I think that’s all right. So then I come up with a colorless, it produce the effervescence.

[Jaz]
So that’s how it indicates it. Indications not through color, but through fizzing. 

[Wyman]
Fizzing, bubble. A lot of bubble. I can shoot you some visual. At the same time, when it bubbles, it breaks down the clock. It’s gone. And at the same time, it reduce gingival inflammation because all the anaerobic bacteria is gone. Actually, we put it in the sulcus, we apply and I show you some cases. Amazing the 10 minutes information just disappear. 10 minutes, gone. Gone. 

[Jaz]
Now what I’m saying in my head, ’cause I want challenge, I want to question. I’m remembering, Professor Zjilstra-Shaw from Uni Sheffield, she used to say to me that, I know it’s not a mouthwash.

I know it’s not a mouthwash, but she used to say, it’s like when you go to the car wash, no matter how much solution chemicals they use until they get the elbow grease, until they get the sponge and they mechanically clean your car, it will be super clean. So it won’t be super clean unless the, until you get the mechanical. Is this solution a substitute for mechanical plaque removal? 

[Wyman]
It’s a substitute for mechanical cleaning. To me, there’s no need to do polishing anymore. No need to do- 

[Jaz]
Does anyone need to brush their teeth anymore? 

[Wyman]
If they use it every day, they don’t need to brush your teeth.

[Jaz]
That’d be an expensive thing to do, right? 

[Wyman]
Very expensive. Yes, they can do it. That is very expensive. Really expensive. 

[Niki]
That’s what you use, right? Magic 3 on your cell phone. 

[Wyman]
Yeah. So you can use it, but it’s very, very expensive because the product’s expensive, but I still- 

[Jaz]
So what problems are you solving then?

[Wyman]
I’m solving that with children to kind of brush their teeth properly. 

[Jaz]
And thus they will not get white spot lesions because the oral hygiene is improved because you’re making it easy for this uncompliant or difficult population who struggle and then the elderly as well, I imagine. 

[Wyman]
The elderly and in fact, everyone. Those people who doesn’t like brushing their teeth basically. And then, and especially if we have any gingival inflammation and the reason why the patient do not brush their teeth with the gingival inflammation because the bleed, they still scared to brush.

So if you can get rid of bleeding and show them that oral hygiene is too important, I don’t want them to use the Magic 3 every day, maybe once a week, once a month, and go to see the dentist every three to six months. Just a prophylaxis as far as Magic 3 just a prophylaxis system. 

[Jaz]
So it’s like those anxious patients, right. They haven’t been the dentists in years. And then to even go near them if they use a gel to get their bacterial load lower and then less pain when they’re actually having the mechanical means. Is that what you had in mind as well? 

[Wyman]
Yes. It’s no pain. It’s no mechanical means that means we can remove plaque, no noise. No vibration, I think to the dentist across. 

[Jaz]
Oh, the anxious patients. That’s amazing. 

[Wyman]
No aerosol. It’s a no brainer. 

[Jaz]
So next pandemic. 

[Niki]
Dr. Chan never shot during the pandemic? 

[Wyman]
No, no aerosol. and it’s not only just remove plaque, it’s remove plaque chemically so we don’t have to use mechanical means. It dissolved the plaque away. Probably seen a lot of chemical, dissolve the stains away. Similar stuff just dissolve the plaque away. It just use water to just three, one water. Just wash it. It’s nice. The teeth for the first time, you will see your patient’s teeth shines. They shine, they’re shiny.

[Jaz]
But I mean, if they’re using it for 10 minutes, then it’s not there to whiten the teeth at all. It’s for biofilm removal and inflammation. And Niki, you told me abscesses, that’s an interesting one. Tell me about that. Pericoronitis makes sense. 

[Niki]
Pericoronitis totally a lot of sense.

[Jaz]
But abscess is. 

[Niki]
It acute germs. Anaerobic. It’s anaerobic germs. 

[Wyman]
When you get rid of the germs, you can reduce the inflammation. Mainly it’s to reduce the inflammation. Gingival. We’re not talking about periodontal. That’s gingival. 

[Jaz]
Okay. Okay, fine. And in terms of evidence-based, where are we at now? ‘Cause obviously it’s a new product. Where are we at now in terms of the future? In terms of evidence based? 

[Wyman]
Evidence based recognition. So I think the best evidence will show a lot of cases, case studies. I think if you don’t do it yourself, see it in front of all eyes. You can read a hundred of papers, you still don’t believe it.

You actually need to do it. Try it. If it doesn’t work, just say, well, okay. I’ve been cheated. If it works wow, to say it works. 

[Jaz]
I mean, Niki showed me his own cases. So I’m very interested in this. When do you think this will be available in the UK? 

[Wyman]
It’s available now. So I launched that, I actually launched that in Shanghai about a year ago, which is a show. And then I launched that in the Dubai. And then, now we’re gonna launch this in London in the Dentist Show. Dentistry show. 

[Jaz]
You had it here first.

[Wyman]
We’re gonna do live demo. Please come and see us and be a model as well. And if you have any gum inflammation, come and see us. We get all them for you, I mean, gingival inflammation. 

[Jaz]
Amazing. Well, how can we find out more? Like obviously the Dentistry Show. Have you got like a website or more information? Anything you want to basically, ’cause we have a very curious, geeky community. Or just say, wait till October or in the future I can add the links or –

[Wyman]
Yeah. Wait till October. Just come and see us. So you won’t miss us. It’s gonna be a big crowd. 

[Jaz]
Amazing. 

[Niki]
And you’ll be able to see it live. 

[Wyman]
You’ll be able to see Magic 3 treatments being done live. If you wanna be a model, by all means, let us know and you can come and get it done yourself there. We’ll be also presenting sort of the different uses of Magic 3, while the dentist patient is having the Magic 3 treatment done.

So the funny thing is, I’ve been using it for five weeks in my practice in Romford. I started off just by telling people, look, I’m gonna do your cleaning a different way without torturing you. I’m still charging you banter, nothing else. But if you’d like it, tell all your friends. Three weeks after doing that, we had people come into our reception.

I want hygiene them, but I want the magic treatment. I want the magic treatment. My receptionist was not clued on at the time. She said, we are a dental practice. We’re not a magic center. And then my other dental nurse had come out and said, no, no, no. That is for treatment that Dr. Chan is doing there.

So we haven’t made it sort of common knowledge that’s available. Really the Dentistry Show is when we are gonna make it available for everyone. But it is available now. 

[Jaz]
Thanks for allowing this podcast be the first one to talk about. 

[Wyman]
Amazing community. Definitely. They deserve it. They do. 

[Jaz]
Okay. Awesome. Well, I’ll put, when you do have more links available, I’ll add them in the future, obviously as we build on the content. But I look forward to have you seeing you in the dentistry show to actually see it in action. I know you’ve probably got some with we will talk about the video.

But anyway, you have to join us guys. You have to join us in the video segment of this podcast. Okay, so this one was for anyone on Spotify, apple, and obviously community on Protrusive Guidance and YouTube to listen into. But the next one is not amenable to Spotify or Apple or audio.

Next one’s been very visual. I will show you the case of like a common problem I’ve seen whereby the incisal half is, is gray, like is this amenable to whitening? And I’ll show you a case that I think a patient lied to me. And I’ll show you that. I think she, she was telling me she’s whitening, but she wasn’t whitening.

Okay. And I will, you tell me if you agree. So if you want that guys, you stick around for part two of this must listen to, must watch episode. Niki, Wyman, thanks so much for this one. Catch you in the next one. 

[Wyman]
Thank you. 

Jaz’s Outro:
Well, there we have it. Guys, thank you so much for listening all the way to the end. Thank you also for our guest, Niki, for helping to arrange this and supporting and helping Wyman Chan with the Magic 3 launch. Before I talk more about that, again, you can get CE or CPD credits for this episode. We are a PACE approved education provider. If you’re watching this on the app, scroll down below, answer the quiz, claim your CPD, and if you’re watching on YouTube or listening on Spotify, get yourself on the app.

Come on, especially if you listen to all the episodes you can rake in the 52 new hours of CE every year. That’s just the new CE, not even including the masterclasses and the old episodes. So you’ve been a long time lurker. It’s time to finally say hello to your community at protrusive.app. Hope you enjoy this particular episode, asking all of our whitening questions.

You can get involved, right? Like when you are like on the community, we give you opportunities to ask questions to our guests, just like today’s episode. Now, don’t forget, if you’re interested in Magic 3, which has really piqued my interest, head over to protrusive.co.uk/magic3. There’s a special promotion for October and there’s an ongoing discount just for Protrusive members, so to take advantage of that is protrusive.co.uk/magic3.

I’ll also post it on the centric relationship section of the app so you don’t miss out. Thanks again my friends, and catch you same time. Same place next week. Bye for now.

Why should Dentists be talking about screen time with parents?

Are smartphones even safe for children?

What is the right age to give a child their first phone?

Laura Spells and Arabella Skinner join Jaz in this thought-provoking episode to tackle one of today’s biggest parenting challenges: smartphones and social media in young hands. Together they explore the impact of early phone use on children’s health, development, and mental wellbeing—and why healthcare professionals should be paying close attention.

 Protrusive Dental Pearl: Live by your values—not your profession, spouse, or children. Don’t sacrifice for them; choose what aligns with you, so love never turns into resentment.

Need to Read it? Check out the Full Episode Transcript below!

Key Takeaways

Highlights of this episode:

🔹Seven Habits of Highly Effective People by Stephen Covey for habits that support balanced parenting and leadership.
🔹 Kindred Squared School Readiness Survey on how early screen use impacts child development.
🔹 Follow Health Professionals for Safer Screens for practical tips to share with families, and on their Instagram for bite-sized advice
🔹 Support the Smartphone-Free Childhood Campaign to delay smartphone use in children.

If this episode gave you new insights, you’ll definitely benefit from Parenthood and Dentistry (Even if You’re Not a Parent!) – IC025

#InterferenceCast #BeyondDentistry #Communication

This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance. 

This episode meets GDC Outcomes A and B.

AGD Subject Code: 550 PRACTICE MANAGEMENT AND HUMAN RELATIONS

Aim: To provide dental professionals with an understanding of the health risks of early smartphone and social media use in children, and how dentists can play a role in safeguarding and guiding families toward safer digital habits.

Dentists will be able to –

Teaser: We have to address the issue in early years because if you've had your child sitting on a screen from day one, by the time they get to eight or nine and they want a smartphone, which is the ubiquity in their pocket, it's really hard to explain to them why they can't have it.

Teaser:
What is the right age for a smartphone?

Yeah. We would say that smartphones with full internet connectivity and everything involved and social media, it’s-

This smartphone usage has become almost the norm for every teenager across the country. And of course what a smartphone does is allow people 24 hours to access to the internet, to social media, to all the unfettered things that we need to, they can see. If you think about whole child health, and that’s how we should be approaching health for our children.

Obesity’s gone up. There’s huge linkages between the seditary behavior of being on screens, but not just the seditary behavior. Because actually if you are sitting on social media or you’re sitting on gaming, you are targeted by fast food manufacturers in a way, way more than you would be on TV. You could have a big argument about the quality of what children are doing on screens when they’re 15, 16.

Or they learning to make music. Are they revising and doing things, but for a two, three, 4-year-old, there are no benefits of being exposed. 

Jaz’s Introduction:
What a time to be alive as a parent. Back when I was a kid, I would go and play football for hours. My parents, they kind of knew where I was, but there was no way to reach me. And the other thing I remember is that when I was a kid, I wanna go to cinema. And then so you agree with your friends that, look, I’m gonna see you at 11:00 AM, at the cinema on Saturday. And there was none of this like texting and WhatsApp and Snapchat and that kind of stuff, and you would just show up at 11:00 AM on Saturday, and that’s a simple life that we lived.

But now with smart phones and social media, I really worry for our children, which is why I brought some experts on to discuss phone use in children and best practices for screen time and smartphones. And so you are thinking Jaz, what has this got to do with dentistry? Well, we have an active role to play as healthcare professionals.

Early smartphone usage and social media is absolutely detrimental to the health of our children. And as healthcare professionals, we have a duty to know about this and to spread the good word. And many of you, like me, are parents, and we need to hear this stuff. We need training.

We need guidance, and that’s exactly what we bring you today. You’re gonna love our guest, Arabella and Laura. But I wanna say thank you to Protrusive community member, Lydia, Dr. Lydia Roulston. It’s been so nice to chat to you on the app, give each other book recommendations, and you are part of this very organization that’s helping schools and communities to realize the dangers of having smartphones in young hands.

Dental Pearl:
I’m so grateful that you’re part of our nice and geeky community. Now, this is an Interference Cast, which is like the nonclinical arm of the podcast, and I usually reserve my Protrusive Pearls for the actual PDP episodes. And as many of you know, I actually struggle when it comes time. I freeze up when it comes time to give a pearl, ’cause I’ve given like 300 in the past.

I’m kind of running out of nuggets. Like obviously there’s an endless amount of dental nuggets and gems out there, but to suddenly pull one out can be a bit tricky. But you know what? I’ve got one from the heart. So even though it’s an icy, I still want to give a pearl. And it’s like from the heart as a parent. In the book, I think it was Seven Habits of Highly Effective People by Stephen Covey.

It talks about being value centered and not being like a profession centered, like your entire world shouldn’t be about being a dentist. Your number plate shouldn’t be dentist. You shouldn’t introduce yourself to, hey, I’m Jaz, I’m a dentist. Like, your identity should not be your profession. The world also shouldn’t revolve around your spouse, nor should your world revolve around your children.

Your world should revolve around your values. And how I’m linking it even more to this theme of parenthood is that, I have a 6-year-old and we go through all the tantrums and behavior issues that all parents do. It’s very normal. And I love talking about being a parent to my patients. I learn a lot from my patients.

I do have an elderly patient base, and so I do get to benefit from their wisdom. And one thing I’ve come to conclude over time is that if you want to do something for your children, don’t do it for them. For example, if you’re making career sacrifices, make sure you are clear that you’re not doing it for them.

Or if you are not going to the gym because you can’t fit in because everything you’re doing, you’re prioritizing your children and you’re doing it for them, then I’m gonna suggest you’re doing it for the wrong reasons. Don’t do it for them, do it for yourself. Whatever you want to do for your children, do it because you want to do it.

Because when the messy times come in, any family dynamic and they start answering back and you have an argument and it gets be heated, you don’t wanna be like, oh, that little s*** can’t believe how much I sacrifice for my son or daughter, and that kind of stuff. You don’t wanna feel like that. They don’t owe you anything.

Any sacrifice you do, anything you do, do it because you wanted to do it. Not for them. I hope that made sense. It just came from the heart, was totally unscripted, spontaneous, and for those on Protrusive Guidance particularly, I wanna know what you felt about that. Anyway, hope you enjoy the main interview. I catch you in the outro.

Main Episode:
Laura and Arabella, welcome to the Protrusive Dental Podcast. I’m so, as a father of two boys, i’m so excited. I read books like Anxious Generation and I follow so much, and I wanna thank Lydia for connecting us. There’s so much I wanna speak to you about, but before we get into the meat and potatoes of this, I’d like some introductions.

Okay. Start with you, Laura. Laura, tell us about yourself, you in healthcare, but also you and your vested interest in this really important public health concern. 

[Laura]
Well, good morning, and thank you so much for inviting us on to speak about this very important topic. It’s become a passion of mine over the last 18 months and is starting to take over my life a little bit.

So how have I got to that point? So essentially, I’m a mother of three boys also in the boy world. The eldest is just turned 11, so we’ll be going into year six in, going into year seven, sorry, in September. I knew from the minute he was born that this was gonna be one of our biggest parenting challenges and I think I’ve been proved right that this is absolutely where we’re at.

And then alongside that, professionally, I trained and worked as a GP. And then three years ago I stopped being a GP and had realized I’ve got an interest in child and adolescent mental health, and that’s where I work now. I now work as a specialty doctor in child and adolescent mental health, and obviously I see the issues that phones, how they affect young people on a daily basis now. 

[Jaz]
You are in the trenches, Laura, you are in the app, so you are the first person to see the negative connotations of this manifest. 

[Laura]
I think in the trenches is a very good phrase. I’m absolutely in the thick of it, and yes, I’m seeing the children that are struggling the most with their mental health in this day and age. 

[Jaz]
The tip of the iceberg. But there’s so much that we don’t see that’s brewing, and that’s like the whole clinical iceberg model, which we’ll talk about, I guess. Thank you so much for that. Arabella. Tell us about yourself. 

[Arabella]
Well, I’m joining in the mother of boys. So I have teenage boys. I have, a slightly higher end of Laura. So I have 19 and 15, so I’ve kind of seen it change and seen it develop. My background’s quite different, so I started life as a business and marketing strategist. So I worked in very big corporations and so I understand how we get people into these things and how they want to do this. But I retrained and did a masters in psychology and then got involved in campaigning for children.

And got into the screens area because parents post pandemic were particularly worried around screens. And in 2022, started working with an organization called Safe Screens, who were one of the first organizations calling for regulatory changes around screens. And then when we started working and talking with Dr. Becky Foljambe, who set up Health Professionals for Safer Screens.

We sort of jumped on Becky and went, who? She’s a GP. And we went, why are you the only health professional here? Why is no one else talking about this? And Becky put out a little tweet. This was all mid 2020 oh, early 2024, little tweet and said any other health professionals out there within 24 hours, she had 30 health professionals she’d never met before.

And that’s how we met Laura and connected to this growing, growing group of health professionals from every single type. We obviously have dentists, we have pediatricians, we have psychiatrists, we have psychologists, lots of speech and language therapists, occupational therapists, mental health nurses, you name it, we’ve got them.

And I work as policy director for health professionals. And our role is about really trying to get the message across that this is a public health emergency and that it needs treated like that. And that this is a problem from 0 to 18. We are volunteers and we’re a volunteer organization, and we are helping to create resources and guidance and working with Westminster and policy makers to try and make those shifts.

[Jaz]
I got into space from being recommended some from books from my within my dental community and some dentists who are members of your, and supporters of your organizations and the book Anxious Generation. It starts off with anyone who hasn’t heard of it. It gives this wonderful analogy at the beginning, like, imagine we were gonna send our children to space and they were gonna live there.

Yeah. And then, what kind of discussions would we be having? And then so essentially it drew this comparison of giving someone a device and how it changes their brain. And there’s so many unknown unknowns. Why are we agreeing to allow the manufacturers and marketers of devices to, and apps that go with it to be able to access our children’s minds?

There is. So it’s a huge problem. You described it as an emergency, and I absolutely agree, but we need to have some structure in this debate. I want to start with the scale of the problem, right? So I think one thing that I think every, I think probably 90% of people listening or watching this right now would’ve seen adolescents on Netflix, which I think, done a great job of really putting this for a while in the forefront of everyone’s minds.

Everyone was talking about this. I just wanna throw that in there and get your opinions on adolescents as a show. But Laura, what is the scale of the problem that we’re facing? 

[Laura]
I think to answer this question, we have to look at the statistics in terms, well, I think first off, we need to look at the, there’s some different nuances within different arguments. So screen time argument, the amount of screen time that children are spending is different to whether they should be on social media, which is a different argument to whether they have a smartphone. And they’re really important differentiations in what we’re talking about. So in terms of the scale of the problem.

Essentially, if we’re looking at smartphone usage, we now know that I think it’s 27% of five to seven year olds now own their own device, their own smartphone to do that. And by the time they’re 11 to 15, it’s over 96% I think. So, this smartphone usage has become almost the norm for every teenager across the country.

And of course, what a smartphone does is allow people 24 hours to access to the internet, to social media, to all the unfettered things that we need to, they can see. And that’s where the arguments sort of merge. But then in screen time, if you add in the fact that we’ve got, they use PCs at school most for a long time of the day.

They then come home and play on gaming devices or sit on the smartphones to scroll. They’re then asked to do their homework on a computer again. So before you know it, we now know that children are spending almost 4, 5 hours a day on a screen device outside of school so that turns into about I think one of the statistics is 35 hours a week.

That’s the equivalent of a full-time job. So the scale of this when you’re talking about screens and how much time children are looking at a screen is huge. It’s really big. 

[Jaz]
Laura, when I was growing up, I watched a lot of tv, like my parents were actually very pro tv. They let me watch as much as I wanted to and I look back and I really regret that. I wish I read more, all those things, but I am where I am and it is what it is. And that’s the tools that they had at their disposal. I didn’t have access to clubs growing up. Personally, I didn’t have access to those kind of privileges, but I consumed a lot of tv, so I’m very mindful with my own children for that.

Arabella, anything that you want to add to the stats? Because really thing, the next thing I wanna ask after this is. Okay. Which is worse? Is it? Are we really, is the public health worry? Is it the social media use? Is it the phone? Or is it just any screen time, including what they’re doing at school? Yeah, so please, Arabella. 

[Arabella]
Well, I think I’d add to what Laura was saying is that we frame this as a whole child health problem. So often this debate, as Laura says, can get caught up in tiny pieces so it can get caught up in, does this cause a mental health problem for a 16-year-old, or does this cause X for this?

And all of those are valid questions, but actually we need to look at it in the round. So if you think about. Whole child health and that’s how we should be approaching health for our children. We know from all the research and there is oodles and oodles of evidence out there. We know that myopia has gone up to sort of 34% of the population from 20%, sort of 15, 20 years.

[Jaz]
Well, what is myopia for those who are not familiar. 

[Arabella]
It’s shortsightedness. So shortsightedness and we know that it’s about outdoor time that makes the difference on it. Obesity’s gone up. There’s huge linkages between the seditary behavior of being on screens, but not just the seditary behavior because actually if you are sitting on social media or you’re sitting on gaming, you are targeted by fast food manufacturers in a way, way more than you would be on tv.

We’ve got lots of legislation around tv. But you don’t have that on gaming. So we know that not only are you sitting there watching it, but you are also getting the messages that these are good things, things to eat. So there’s all these subliminal things that people don’t necessarily pick up. Then you’ve obviously got all the anxiety, you’ve got the suicidal, indentation, all these things that Laura’s dealing with on a daily basis.

You’ve got the comparisons, then you’ve got the societal issues, which was picked up in adolescence. You’ve got the numbers of children who are radicalized and ended up in extremism. So 20% of arrests last year for counter-terrorism were under X. 10 years ago, that was 2%. And the Met Police are absolutely clear that that is a direct link to social media.

So there’s lots of things within this debate that often get ignored because we are concentrating on one exceptionally important area, which is the mental health of 16 year olds. But actually we need to think about it in the round, and that is why we don’t think it’s dramatic to call this a public health emergency.

[Jaz]
Laura, with the kind of child who ends up needing your services and needing your care. If there was an avatar, would you say it’s what the Anxious Generation book recommended, which was suggested, which is 14-year-old girl who is almost suicidal. And that is tragic, you know, but would you say that is an accurate representation of the kind of children who need mental health services as as a child? Is that the kind of demographic that you’re seeing the most? 

[Laura]
At what, 14-year-old girls? 

[Jaz]
Hmm. 

[Laura]
There’s a lot of 14-year-old girls. I don’t know if that’s the most, I wouldn’t know the statistics on what app. I think it’s across the board, to be honest, of all teenagers. And obviously I’m seeing the real tip of problems and there’s lots of children that I see that, you know, with awful backgrounds and really traumatic experiences in the mix.

Very, very difficult, hard times. And the smartphone is, I think, I’m trying to think of the number of children I’ve seen, in terms of who’s been affected by a smartphone. There’s a few. Definitely, we absolutely, without a doubt seeing children that are only in cams because they’ve had been bullied on side on WhatsApp.

And the bullying has got so extensive that they’ve then tried to take their life. And I can say that with my, I have dealt with that child in my clinic. So there are a handful of children in there in the services that are directly impacted purely by social media, by their anxiety levels, that their depression, their mood is all affected by what they’re seeing on social media.

But then there’s a huge majority of children in camps that the smartphone is not the cause, but then a child will become depressed, but then they spend their time scroll through on social media to think they make themselves feel better. But it’s then ends up in this vicious cycle, you get the dopamine hit, but then you end up in dopamine deficit and then it just have this absolute slump afterwards that whilst they think they’ve made themselves feel better, it’s made them feel 10 times worse because all they’ve done is compare themselves to other people in their perfect lives without any backstory to that.

So I think, I don’t know the numbers. I would love to get that research in terms of what’s the impact on our campus children. But I can absolutely say there are a handful of children that have, are there purely because of the phone use and social media use, but then everyone’s there that’s not got a direct impact. It’s making their symptoms worse, I would say. 

[Arabella]
And if I just add to Laura’s point, which is really valid, so Laura’s saying we don’t have the figures of exactly that point. And the reason we don’t have those figures is because we are not asking the question. So it’s only a lot of enlightened doctors like Laura or speech and language therapists who are actually screened for the question. It’s not commonplace to have a child coming in with self-harm and ask them about their online experience. 

[Jaz]
Wow. I mean, I would’ve thought it would be one of the first questions. 

[Arabella]
It’s not, and this is one of the things that we want, we want to change in public health policy, and we’ve created a GP screening tool. So we are trying to roll that out, which has those questions, but it’s not standard, particularly if you’ve got a 10 minute slot to ask these questions. It’s not standard that you are asking those questions. It’s not standard that if you’ve got a 5-year-old who’s nonverbal coming in as a speech and language issue, and speech and language is a massive problem, it’s not a standard question to ask how much time they spend on screens.

And how much linkage, and that’s part of the change we need to get within the health profession because we can’t measure this question because we are not asking this question. 

[Jaz]
Very valid point. Now, Arabella, from your perspective, something that Laura touched on earlier is that we’re actually dealing with, there’s so much to talk about because we’re dealing with multi-facets.

So there’s screen time, i.e., how much time someone might spent in front of tell your computer, which is one thing. Then at what age they get introduced a phone, right? Which is their own personal device. And then the apps that are on the phone are a completely separate problem, but they all encompass in this theme.

What do you think, Arabella, which of these, if we go with the Pareto principle, right? 80% of the problems come from 20% of its usage. What is the most worrisome aspect of screen use that we need to focus on perhaps as part of the emergency? 

[Arabella]
I would say, I think we probably all came to this conversation because of older children, because of the adolescents, because of the awareness, because it’s very dramatic. I think the vast majority of our members are now more worried about early years and in early years, early years the problem is very much about how much time they’re spending on. You can have a big argument about the quality of what children are doing on screens when they’re 15, 16. Are they learning to make music?

Are they revising and doing things? But for a two, three, 4-year-old, there are no benefits of being on screens. Even the so-called educational apps are not beneficial. They’re not researched. But as Laura talks about, they send the gamification of education. So you’ll constantly have a dopamine hit, which means that by the time you’re meant to be sitting in school and paying attention, you can’t do this because you are used to having buzz, buzz, buzz, buzz for every single thing that you do.

So if we had to be really simplistic. It’s very hard to be, because this is stunningly complex. We have to address the issue in early years because if you’ve had your child sitting on a screen from day one, by the time they get to eight or nine and they want a smartphone, which is the ubiquity in their pocket, it’s really hard to explain to them why they can’t have it when everything they’ve seen is is on phones.

As a country, we give no guidance to parents on phones or screen times or screens for little ones there is pretty much unique across the world with nothing there. So we don’t have anything in the Little Red Book. We have nothing in Start for Life. We have absolutely no guidance at all on how much time your kids should be on screens.

So much so that we’ve actually, I’m gonna try and show, but you can see us on our website, and this has been taken by quite a few NHS. We’ve created guidance working with the World Health Organization, guidance with other pediatric associations, with academics, which gives recommendations because we can’t expect parents to know the best thing to do with their children if we never tell them.

Or health professionals haven’t had any guidance on this. So yeah. If I was being simplistic, I would say we need to focus on early years and we need to focus on that clear message. ’cause then we have half a chance of protecting our children as they get older. 

[Jaz]
And Laura, would you agree with that? 

[Laura]
Absolutely. Yeah. And I think the issues and the challenges change as the age ranges change and you go up and that’s again, makes part of the argument very complicated. And there’s two very different clear messages as well.

The message at the beginning of trying to delay a smartphone for as long as possible, I think we’ll probably talk about age and letting a bit, is a different, very different argument to those children that are already in the world of having a smartphone and on social media. And they’re very different messages that need to be dealt with in a very different way.

But I think in terms of how we start to turn this, the new norm where everyone gets a smartphone, certainly by year seven it would seem to start turning that around. We need to focus on the younger years to do that. 

[Jaz]
Well said. I think part of the issue is this generation of parents, myself and my wife included. And that when I was a kid I could just, when I was eight, nine, I would just be in the street and I would come back three hours later. My mom wouldn’t know where I was. And everyone was okay with not knowing where someone was for a while. And now we get anxiety about not being able to see, or not being able to track even with GPS something.

So we are partly to blame as a culture of parents. And so this very, very difficult, I mean, one thing, slight digressing, but I think is very relevant. I saw on my facebook ads recently. A watch targeted for children that allows you to call your parents, which I like the idea of. ‘Cause all you can do on this watch is call and receive a call.

That’s it. Okay. And I mean, I like the idea of that as a way to have that sort of inner safety, that my child’s okay and I can reach them at any point without giving a fully fledged device. So I guess that naturally leads into your thoughts on this kind of approach, but then naturally leads into, well, what is the right age for a smartphone?

[Arabella]
Yeah. We would say that smartphones with full internet connectivity and everything involved and social media, it’s 16 and that’s very much about adolescent brain and it’s about the connection of really developmental tools in there, but also about the stuff you have going on at school and life and the distraction techniques with it to give you the space.

But the good news is that. Manufacturers are starting to recognize this problem. As you mentioned, there’s the watch one, but there’s also HMD Fusion are bringing out a phone in which isn’t as, doesn’t have total internet. It still has some connectivity, but has more protective on it. And I actually went to a launch yesterday, a pre-launch of a phone from a company called Sage, which is producing an iPhone, which has its own unique operating system so no children can get through it, and there’s nothing you can do on it and take all these information off so you have the positives that you need.

You have your wallet, you have your GPS, you could have certain apps on there that you need to go in. Parents can find you, you can make calls, but it’s not distracting. And we need to get to a world where we are offering parents and children a solution that makes tech work for them. And that’s why we are thinking it’s a very much a regulatory framework that can move this.

‘Cause everything shifts so fast. So, if we’re seeing ads now for sunglasses, which have all the AI in. And have everything in there. I mean, can you imagine how confusing that’s going to be for a teenage brain in relating to reality if actually you are not really seeing reality and you are talking to people through your glasses.

It sounds fun, but it’s really quite complex when you’ve got so much going on in our heads and Laura obviously sees the impact of these phones on kids every day and what she’s doing and the children that are coming in. 

[Jaz]
Would you say Australia’s the front runner here and being proactive in this? I recall recently they made it to age 16 to have, I think it was social media, to have age 16. Is that correct? 

[Arabella]
Yeah, they’ve, so what’s great about Australia is they’re actually grasping this as an issue and making it very clear and they’ve put the manufacturers, the software companies on the back foot for making them deliver age verification and showing you have to prove a way of doing it, and there are ways to do it.

However, you get into a question of what social media. So for example, they have taken YouTube out, but YouTube, from three years old, 90% of UK children are using YouTube. YouTube has fast moving, fast loads of fast moving things in it, and it’s actually one of the key ways that children see pornography.

They see violence, they see all these things which they’re not choosing to see, and it’s coming through. They’ve also taken WhatsApp out, and again, WhatsApp is another way for cyber, but massive problem for cyber bullying, grooming all these other areas. So you do get into a problem of what you define as social media.

But actually at least they are doing something. And they are recognizing it’s a problem. So that has to be a positive. 

[Jaz]
Laura, any comments on this theme? 

[Laura]
Yeah, I think I’ll just go back to something you said about a couple of things. So one was about Jonathan Haidt touched on this, doesn’t he? That we’ve moved from a play-based childhood to a phone-based childhood. And that that’s happened whilst all the devices have come up and become more in enticing to turn the child inside. At the same time, all the parents have been made to feel really anxious about not watching their children.

And there’s less eyes on the street. There’s more women at work. There’s many people looking out the houses, checking it, Tommy next door’s. Okay. And he thinks that that’s, he describes that as that phenomena where everything’s come together. And of course, the media is also to blame.

It’s not the parents to blame that we’re feeling so anxious as parents, but it’s absolutely part of the solution in that we need to empower parents and we need to free them really, because there’s some arguments against tracking in terms, I’m not saying whether what’s right or wrong, every parent has to make this decision on their own, within their own base, their own element of safety and their own confines of their own feelings.

But there are arguments in terms of if your child knows you’re always being tracked, the fact doesn’t develop their confidence in the same way. It doesn’t develop their problem solving skills in the same way they know what are you actually telling them if you are tracking them the whole time that this world’s unsafe, that they, that they’re not safe there to go out and about.

So there are some and also do you trust them? Are you saying that you don’t trust your child if you have got constant tracking device on them? So there’s some, I think we’ve got a long way to go before people feel safe to not track their child. And I think that’s one of the biggest problems about the devices.

And I think it’s one of the big pools that parents have of buying their child a smartphone because it has the tracking ability on it. But when you do think about it, there are some other arguments. There is another side to the argument whether we should be tracking all the time. And it is sad that children have not got that freedom as much, and as parents, don’t feel we can give it to them.

[Jaz]
If you were to have a overnight this power to do anything you could. And starting with the age, I know Arabella you said age 16, is the time you should even consider having a smartphone. Laura, would that be your number as well in terms of age based on what you’re seeing?

[Laura]
Yeah, definitely. 

[Jaz]
And what other, let’s say we had this perfect society where you two were coming together to set the rules. Can we just spend a few minutes on what would these rules look like? And these are like ideals based on the best available research that you are aware of.

And based on you in the trenches, Laura, and all the work that you’ve done, Arabella, what would be the perfect standard? The perfect world? Arabella? 

[Arabella]
Well, you’d start with no screens before five. And that doesn’t include tv, actually. What’s interesting is we’ve known for 20 odd years that having background tv noise or radio is not good for speech and language in young children, but actually shared TV from brilliant sources like public service tv, such as Bit CBBs, where you are sitting together at, it has a narrative, it has a beginning, it has a middle, it has an end, and it has a discussion point and is defined.

Fast moving, boom, boom, boom. Not great, but no screens before five and then really intentional your use within education. Why are you using this piece? What’s its value? Where’s it’s adding to it and we are not saying that there isn’t value in tech, there absolutely is value in tech, but really thinking about it.

So it’s not a standardized piece. And we are not gamifying education. We are hearing awful things about children who get to school and they can’t sit up on a rug because they’ve lost their core strength because as babies, they’ve literally just sat on a screen all day. And they’ve been sat on a corner, on the side.

And this came from a fantastic piece of annual research by Kindred Squared called School Readiness. And they look at children, it’s got worse and worse and worse. So that’s the first thing I’d start. Really intentional work. Work in schools. Separating the thought process behind what’s the ed tech that makes frees up teachers times to teach versus just putting children in front of it. And then Laura, do you want to pick up on teenagers and what you do around them? 

[Laura]
Yeah. If I had a magic wand, I think Snapchat wouldn’t have been invented. That has to be one of the biggest cause of some horrific problems. 

[Jaz]
And YouTube shorts. 

[Laura]
Yeah. 

[Jaz]
Like the shorts are absolute so like, dopamine heavy. Short, short, short. I hate that. 

[Laura]
Yeah. Because they’re just so easy to watch and the before you know it hours have passed by and it’s killing our concentration skills and it’s addictive. I think WhatsApp, I would never also have invented. And I mean that’s the bane of all of our lives. It’s certainly the bane of my life.

It’s the only thing I have my screen, it’s what takes up most of my screen time. ‘Cause I’m running four people’s lives on it. And for these poor children that are having to navigate the nuances of WhatsApp in terms of, they make a mistake at school and before you know it, they’re just cut out of a group.

That’s it. They’re banned, they’ve been taken out and the impact of that on your self-esteem. You don’t even know what you’ve done wrong. No one’s able to communicate or work out these friendship issues in person. You’re just barred from the group and that’s it taken out. So I would absolutely get rid of WhatsApp, but the positive thing I would do and change if I had a magic wand is improve community.

And that’s where argument gets so much bigger because that’s what people are missing, I believe, and that’s what they’re trying to find on social media and through the phones, is that feeling of community. And we don’t have shore start centers, we don’t have community centers, don’t have youth hub clubs, anything like we had.

And that’s what that gap is filling, and that’s for me would be where my magic wand would lie. We need to give the children something else. We need to make real life better than the on life version. 

[Jaz]
Thank you. Now we are speaking to dentists. Mostly it was dentists who listened to this podcast. So I mean, I could say, what advice would you give to parents from their lens, but I think I can give them the websites for the organizations to represent and they can get some really good guidance for themselves as parents. Not only just healthcare professionals, but as dental professionals.

What do you think, what kind of message do you wanna give to the dentists and dental therapists and dental nurses listening out there for how to change anything about our practice or the way we take a history. Or the advice that we give to help this problem. Help this, help- 

[Arabella]
I think, Jaz, you make a really good point because one of the big things we see is about body comparison and it’s about body dysmorphia. And as a teenager, you are meant to be comparing yourself to people. That’s kind of what you do. But your world would’ve been 20 people in your class. And we all remember what it was like and you felt awful. But suddenly you’re comparing yourself to thousands and thousands of people.

But also you are getting really dodgy advice from people who are self-professed experts in this area across, across social media. Quite a famous thing, which particularly talks about children’s teeth or teeth. You can fall down your own teeth, so just file them. It’s really easy. That’s a big trend that went around social media. 

[Jaz]
Yes, I remember. 

[Arabella]
Which is quite terrifying. 

[Jaz]
Also, mewing and like chewing hard things to drop your jawline, that kinda stuff. Yeah. 

[Arabella]
All that kind of stuff. And so I do think some of it will be about actually having the conversation with a child who comes in and isn’t wearing their brace properly because they think they can achieve it through mewing to ask, where did you get this information from? Why do you think this is pointing ’em in the right direction of trusted sources?

I mean, one really clear way we are seeing it at the moment is around pregnancies and hormonal contraception. I know this isn’t dentistry, but it’s the same kind of problem. So there’s a lot on online about hormones, hormonal contraceptives or coils or things like that are dangerous and they’re gonna give you cancer and they’re gonna give you all these different things and you shouldn’t do it.

We’ve now got the biggest increase in teenage pregnancies that we’ve had in a very, very, very long time. And you talk to our GPs and they will tell you the number of people who, or teenage girls who, young women who come in and go, I want to have X, Y, Z, but they don’t, they refuse to take HRT. They’re having spent a lot of time trying to understand where did you get this information?

How did you do this? Not HRT, sorry, contraceptives, which is a massive problem and that’s very similar to the kind of health advice I imagine. You get people who turn up, who’ve bleached their teeth in very odd ways or they’ve try doing different things. 

[Jaz]
Oil pulling for a while. This was 10 years ago. There’s a huge trend where huge cavities in the mouth that have a structural loss way beyond remineralization, but they were hopeful that magically, ’cause this is what they’re seeing on social media and that kind of stuff, magically animations of teeth with big holes magically growing back.

And they believe it and they actually believe that this just, they’ll spend half an hour swishing coconut oil in their mouth. But they won’t spend the 15 minutes in total per day doing the correct oral hygiene routine and that kinda stuff. So yeah, we see this misinformation disinformation all the time.

[Arabella]
Yes. And I think you have an incredibly important role in when children come into you and have, or young people asking where they got this information from and really trying to explain to them why it’s not safe, why it’s not helpful, which is what a lot of our GPs are now doing and questioning when people come in, particularly with oral contraceptive questions.

[Jaz]
I think the other role we have, and Laura, beyond you after this, because the other role we have as dentists is that a good, a decent percentage of population, I wish it would be higher still as a public health objective, but a decent population of our decent percentage of our population come to the dentist routinely.

Whereas the GP is a bit like as and when you need, and it may be a different GP, whereas hopefully you get a relationship. It’s relationship building with our patients, which is another adult who can guide you. Yes, our remit is oral health, but the key word there is health.

So, Laura, the reason I’m asking you here is, you see those in distress. You see, like I said, the very tip of the iceberg. We as dentists can help you in the lower down in the iceberg. In the preventive role. We are also in the front line of healthcare where we can, we want to focus on prevention. We give them advice about their sugar intake, which is very important for us to do.

But are we crossing any boundaries if we start saying about, asking parents about screen time, like, maybe not, I think maybe we should be helping with this problem. Well, what do you think a dentist should be doing? 

[Laura]
Well, I’ve see spoken to lots of children now and there’s children I see that are difficult to engage. They don’t want to be there. They don’t want to talk, they don’t want to talk to you. But as soon as you start asking about their world of social media. They come alive. For me, this has been a real turning point for me, a learning point and a point of acceptance that this is their lives.

And once you start inquiring about their online life, they will start to tell you about it. And often you’ll find, they’ve got, they don’t just have one account. They have 3, 4, 5 TikTok accounts. That will all have a different purpose to them. That will then , there’s a reason they’ve got each different account.

And until you start asking these questions, you won’t find this information out. So I think as all health professionals, we’ve got a responsibility to check in with that child. And you know, if we’re struggling to engage with one, that’s probably your way in, is to find out what their online life is like. And that’s not in a judgmental way, that’s not in a checking in way, that’s trying to, this is how we now have to engage with our young people. 

[Jaz]
Well it’s building rapport as well, isn’t it? 

[Laura]
Absolutely. Yeah. And when you start asking those questions is when you start hearing anything scary or things that aren’t right, or then you can start giving you alleyways about asking where they get their information from and where, who they trust in their life, who are their trusted adults, who’s in charge of, who can help you with taking control of your healthcare?

And I don’t think there’s any, I think you’ve got, I think as health professionals, the more of us that understand this message that we have to keep asking and that we come back with, well, did you know the recommendations are no more than a couple of hours a day for your screen time. But as you get older, after that young age, the more of us that can put that message forward, then it’s just gonna be the more they hear it and at some point you’d hope they start listening as do the parents.

Just planting that seed in terms of there is more you could do than just be looking at this screen all day, every day. Do you know what the damages could be doing? So I think it’s about opportunistic chat and finding a way in with the teenagers and the young people because they’re become, they’ve got a real risk of just becoming more and more cut off from us as humans from those generations above that still know the balance is really important. 

[Jaz]
Excellent. And I think the word that was screaming in my head there was safeguarding. Right? We, as dentists, we have a safeguarding policy. We have a safeguarding lead in our practice. We have a separate one for adults.

We have a separate policy for children. And I think that as dentists we should probably revisit our safeguarding policy and consider does this actually, are we just there reactive? Like when we see an obvious, real tip of the iceberg kind of stuff, or as proper safeguarding, can we probe a bit further and see if we can help, well assist in these children getting the right help they need.

So that was the thought coming to my mind. I see you, nodding there, Arabella, anything you wanna add about the safeguarding aspect in healthcare? 

[Arabella]
Well, I think this is a safeguarding issue. And actually you said at the very beginning we had a conversation around, would these exist if we were creating them Now these products? Without any safeguarding in? And we’re in a mad world where we have all these restrictions and regulations around things.

If you have a teddy bear where the eye comes off. It gets recalled into child safety. Yet we have these products where we know, and the coroners have linked children’s deaths to these products, and yet they’re on the market. And we are having to prove that they’re not safe with ridiculous amounts of causal information, whereas actually it should be the other way round.

These shouldn’t be on the market until they’re proven safe. And as health professionals, the core of what you guys do is not just safeguarding, it’s also precautionary principle. Why we shouldn’t, we have more than enough evidence from not only the academic research, but from your day-to-day experiences.

You talk to our emergency health consultants, they are having all these kids, not just the mental health issues coming in, but teenage girls who’s been asphyxiated because of the sexual violence that they’ve seen on screens and they’ve seen on, I mean, these are really scary things that are happening.

And yet, if it was a drug, it would be banned tomorrow without a doubt. But because it’s tech and because we confuse and conflate benefits and harms, we are not looking at it in that right way. But yes, this is at the bottom line, as you’ve put it, this is a safeguarding issue. This is real genuine harms and you have the most extreme of obviously, suicides, but also the kids that Laura is seeing.

But we shouldn’t forget that all these little things are impacting how our children relate and their long-term health. So one thing that’d be wonderful is because, as you say, dentists have a relationship with families from day one. Very young. It would be wonderful if you had some of our leaflets around guidance just sitting there.

[Jaz]
I was just gonna say that. I was just gonna say that. ‘Cause we have, we were leaflet heavy, we leaflet rich. Even just sending ’em an email sometimes with the correct video of brushing technique, but to be able to distribute your stuff. The volunteer work you do is amazing. We can slowly help and I’ll say any petitions we can sign, I’d love to put them for our colleagues and then for them to spread it amongst the parents because I think all wonderful, as parents, we are concerned.

We are in it together. I hope to think, and the vast majority of us want to get, we need guidance. I think we. Now we don’t know what’s the best way to handle this unprecedented, uncharted territory, if you like. And we need guidance. We need help. And what you guys do is you Protrusive Guidance, you give us some advice, some recommendations. So I think if we can distribute that, not only through the safeguarding and children, but actually to parents that come in who also want to help their child. 

[Arabella]
Yeah, I mean, all parents want the best and it’s very confusing, the information that’s given at the moment. It’s very confusing, this idea of I have to help my child get ahead, which is totally true, but being able to swipe on a smartphone isn’t the same as being able to code or being able to understand how AI works or those, and that’s the critical thinking.

And we seem to have conflated these two things and I think it’s very hard as parents, as I said, I’ve got a four year gap between my teenagers who are late teens. The difference between those two year groups at school and their experiences in just four years is mind blowing, and that’s how fast it’s moving.

It’s really hard for my experience of being a parent when my kids were four or five, fundamentally different. Fundamentally different, and that’s what we have to get our heads around. 

[Jaz]
I’m gonna ask you some personal question, and you may decline this, and that’s okay, right? Do your children have Snapchat?

[Arabella]
Yes. Because it was too late by the time that I realized the issue. 

[Jaz]
It was almost grandfathered in, right? Because everyone just had it. And before we see what hits us, they’re all in that. It’s a bit like the kids, they pick up YouTube and now suddenly Australia takes it away like, well, we’ve had this since age four, right? It’s a bit like that. 

[Arabella]
And Laura made a really good point early on that actually we have to look at these in different lights. We have an opportunity to protect our children who are younger by not bringing it in and how we manage those children who’ve already got these things. And in my teenager’s lives, Snapchat is the way they communicate with each other, where they organize it.

If I took him out on Snapchat at this point, he’d be no longer in the playground. And that’s why this is a collective action problem, why it’s easier to bring it in in gradually as a possibility. Some schools bring it in. Year seven and they gradually do it. But this is absolutely a collective action problem and we need to start early so that it’s just not even a consideration when currency journals get to 11. 

[Jaz]
Laura, what advice would you give to dentists who are parents, and they’re worried about their children’s social media use and maybe their kids are on Snapchat and they know about, as you said, one of the apps that we would ban if you had a perfect world will be, will be Snapchat.

What advice can we give to those children who are already using that social media and then also separately, before they get onto those apps? The whole thing about delaying it as much as possible, but then the whole thing about I’m the only kid in the class that doesn’t have this, that’s a different thing. So that’s not part B, but part A, what advice for those already using those kinda apps?

[Laura]
I think my advice would be to educate yourself because power is knowledge and the more knowledge you have about this, the more powerful you feel as a parent. And this is an incredibly difficult thing for a parent to deal with.

And you have to be forearmed to do that. I’m an absolute dinosaur. My children would call me. I am so strict and I know that I’m gonna be challenged in September. My real challenges are coming in September. None of them have a phone. We took the iPad away from them. I try to keep them off YouTube as much as I can.

They’ve got a switch, which they’re not really interested in because they’ve only got Mario Kart. I’m at the very opposite end, and I know I am about to have a very big challenge ahead of me, and I am just holding off as long as I possibly can. But the only reason I can do it is because I have absorbed myself in this stuff for 18 months and I see the effects and I feel so strongly.

I have that I’m able to say no. And whilst it’s me putting my head above the parapet, it’s very difficult for me then to make my son put his head above the parapet, who’s quite a different character to me. So my middle son is standing there with a placard of, don’t ever use a phone that’s why these are individual choices that you have.

You know your child, you have to work with that child. And you have to find compromises. So I think my first tip would be to educate. I think my second tip would be we need to empower parents. At the end of the day, you can say no, and you can also, whilst once those children who have already got a phone, they’re already in Snapchat, that is their communication tool.

It’s almost impossible to take it away completely at that point, but you can restrict it. One of my very good friends who’s a GP. She’s got four children, her eldest two have got phones. At 15 and 13, she made her eldest daughter who was on Snapchat all the time and once, once my friend got involved in this campaign, she reduced her Snapchat usage to three minutes a day.

She said, that is it, that’s all you’re allowed for three minutes. So she can go on, check it and come off and she’s done that. You can do it, but you have to be empowered. You have to know why you are doing it and that you are doing it for the better good of your child to do that. 

[Jaz]
These are tough family dynamics. I mean, these are some of the toughest things we face as parents. 

[Laura]
Absolutely the toughest thing we face, and I knew that was gonna be the case from, as I said, the minute my first child was born. It’s not a position any of us want to be in. It’s not a position any of us should be in, and it’s a horrible, horrible topic because you don’t want to be judgmental and try to run these campaigns and not be judgmental.

It’s very, very difficult not being judgemental. We are not blaming any parent. This is at the norms that have become normal and no parent wants their child to be left out. And that’s fundamentally the bottom line. You don’t want them to not be communicating with their friends, but we have to encourage this in a safe way.

And I think the other thing we can do as parents is reduce their screen time, but got to be proactive and put in other stuff as best as you can. And that doesn’t necessarily mean spending money or going to all the clubs. You just ask your child, ask your friend. Ask your child to invite a friend to your house.

Encourage real life person play dates. Encourage them to go to the park together without a phone. And when you have play dates at your house, be brave and say, put your phone in here, guys. And the more you make a stand and do that, the braver you feel the more empowered you become to do it. But it’s really, really scary. It’s a very, very scary move at the beginning, but it does feed on it. You do become more empowered the more you do it. 

[Jaz]
I just wanna add that, sorry, Arabella go for it. 

[Arabella]
I was just gonna, and building on where Laura’s coming from. She’s absolutely right because all the research shows that if you work together as a family to create a digital plan and you have guidance in, it’s much more supportive for children, but also adults working.

We actually have created family digital plan plans for different age groups, and they’re really simple tools where you sit down as a family, obviously not when they’re very little, but actually very importantly, sit down as a couple. And any other carers to talk about where do you have things, what’s important?

What’s there? So yes, they might have things, but don’t have them in the morning. So the first hour of the day. First hour before bedtime. Never ever, ever have them in the bedroom overnight. Any type of devices. Don’t have them at meal times. You might decide that you don’t have them in the car on the way to school because you listen to a podcast or you talk to each other, or you do different things.

But you can decide that as a family. What’s important, but also incredibly important is we as adults need to actually show our children what? Because children copy us. 

[Jaz]
Perfect. This is exactly what I was gonna say. It was that we need to be role models for our children. 

[Arabella]
Yeah, we absolutely do. And it’s really hard because we couldn’t live without our phones partly because of work, but partly, as Laura said, you are managing all your children. So I spend half my time looking on spawn to find where their matches are meant to be or doing my order or whatever. And one of the things you should be doing with younger children is you should be narrating what you are doing.

So when you pick up your phone, you go, mom’s just looking up when your football matches. Or Mom’s just doing so they can understand because otherwise it just looks like you are always on your phone and they probably think you’re on TikTok. Because that’s what they’d be doing. So as adults- 

[Jaz]
Well one of the reasons I got a smartwatch is just because the odd notification, I can just see it ’cause not emergencies, doesn’t need me and put it away and they’re just, rather than picking up the phone one, that was my main driver for getting a smartwatch is so I can eliminate having the phone in my hand.

‘Cause my son’s watching me, so I’m very mindful of that. I think it’s a great point. Another point, I love the idea of a digital plan. So we have a rule that in the car we don’t do any screens in the car. We can listen to songs. We take turns being the youngest in the middle, and then, and my wife and I, we all have turns about, okay, what’s your song?

I am trying to put on a Punjabi song. So I’m trying to teach them a mother tongue and stuff. So, that’s great. Unfortunately, we need a better digital plan at home, right? And hours meaning more boundaries there. And I love that. A great thing, a great reel I saw recently was Jordan Peterson, the guy who wrote the 12 Rules for Life.

He said that you need to run your family like you’d run a small business. You need to actually be purposeful and therefore you need to call in the meeting. Okay guys, we’re having meetings, we’re doing meeting notes, like family meetings and actually making plans and being purposeful. So that’s how you run your family. I love that. And what you said about making a digital plan just weaves in so well into that. 

[Laura]
Yeah. And they’re small actions that don’t feel as scary for a parent to stand up and say to your child, hey, we’re gonna introduce some small rules and we are all gonna do it. It’s part of the parents as well.

So things like when you come in, your phone goes in this box for the first hour of the, a first hour after you come home from school, so that you talk to me. And you all do that. You all put some people at the box at the bottom of the stairs where all the phones go in before they go up to bed at night.

So you need to do that as well. And obviously, you’re an adult and you’ve got parents that might be, you’ve got your elderly parents that you’re worried about, you have to bear those sort of things in mind. But as a general rule, those are small changes that you can do.

The other, the last thing I would say is on this is that, the really, really important part of this is that we are getting so much evidence that the young people themselves want this to change. And this is, they can see that they know that they are spending too much time, that these phones are addictive and taking over their brain.

So that also really helps empower a parent and the teachers to know that the young people themselves are really wanting change in this field. They know they’re spending too much time on their phones and social media. 

[Jaz]
Totally. Amazing. Any last points? ‘Cause I’ve really enjoyed this chat. I think some great action tips in there. Great ideas, and I think people can take action and at the very least, if everyone just download some of your guidance and put your websites, and I’ll put everything in the show notes. What are the best websites to go on to learn more just so I can all, I’ll put it in the show notes, obviously, but just so I can hear it from you, Laura.

[Laura]
So, obviously, as a health professional, it’s got to be the health professionals for saferscreens.org. As a parent, I cannot recommend the smartphone Free Chartered campaign. High enough. It’s fundamentally changed my life on so many levels. The aim of it is to find other parents that feel the same as you, that you want to hold off together, delaying giving your child a smartphone, and it builds communities in your area, and you can get as little involved or as much involved as you want in that campaign. And I honestly can’t recommend it high more. 

[Jaz]
Amazing. Arabella? 

[Arabella]
Those are the key places as well. And if you do follow social media, then please do follow the health professional social media. Sites because we try to do bite-size ideas and easy swaps for parents to try and bring people in and link and raise awareness.

But we also really importantly, need to raise our voices. Politicians do respond to parents and they respond to health professionals. And if you are talking to your MP and you’re concerned about this, write to them. Tell them about examples that you are seeing in your clinics if you are having kids coming in.

Your example about the coconut oil, I mean, that’s a brilliant anecdote because it shows the real, so things like that, that you can communicate and communicate to your royal colleges, because actually every royal college should have a clear policy on social media. It should have a clear policy on smartphones and digital, and most of them don’t at the moment.

So the more that you can raise it up, your professional organizations and say, this is something that you are concerned about from a safeguarding, it brings that message that all professionals, all health professionals, but also the police are worried about it. Education is worried about it. All these different people, that everyone is worried about it, that will drive change. It will shift things. 

[Jaz]
Well, Laura, Arabella, thank you so much both your time. More power to you. Please keep fighting a good fight. Us as the dental professionals, we will support you. I’m gonna make sure that I plug this everywhere in the community, in our apps and in our channels to get more, more followers for you, more distribution, more political action, wherever we can do to help the future of our world, which is our children. So thank you so much. 

[Arabella]
Thank you. 

[Laura]
Thank you. 

Jaz’s Outro:
Well, there we have it guys. Thank you so much for listening. All the way to the end. Any links and organizations that we promise, we will put in the show notes. If you can help and support these organizations, it will make the world a better place. So please do so.

If you’d like to get some CPD or CE, that’d be great. If you’re on Protrusive Guidance and you’re paying subscriber, please scroll down, answer the quiz, get 80%, and we will send you that certificate. Our members easily rack up 50 hours of CPD or CE every year easily. There’s a bank of over 450 hours of CPD on the platform with at least 50 new hours created every year.

Head over to www.protrusive.app to join the nicest and geekiest community of dentists in the world. As ever, love to Team Protrusive. Thank you so much for everything you do, and in this episode, love to all the parents out there. The struggle is real. I’ll catch you same time, same place next week. Bye for now.

How can you tell if a root canal treatment is truly successful?

Do you always need cuspal coverage after a root canal?

Are hand files still relevant, or has rotary completely taken over?

And does GP pumping really improve the effectiveness of irrigants like hypochlorite?

Emma returns for another Protrusive Student Series episode as she heads into her final year of dental school. Together, we explore the fundamentals of endodontics – covering restoration choices, success criteria, instrumentation, and irrigation protocols.

This episode breaks down the basics every student and young dentist should understand, while also tackling the common debates and real-world challenges of endo.

Need to Read it? Check out the Full Episode Transcript below!

Key Takeaways

Highlights of this episode:

Resources mentioned:

Check out Simple Re-RCT Cases – ‘How To’ Guide – PDP233 for more Endodontic insights

#BreadandButterDentistry #EndoRestorative

This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance. 

This episode meets GDC Outcome C.

AGD Subject Code: 070 – Endodontics (Endodontic infections, microbiology, and treatment)

Aim: To provide dental students and early-career dentists with a structured understanding of endodontic fundamentals, including instrumentation, irrigation protocols, success factors, and restorative considerations.

Dentists will be able to:

Teaser: You go to dental school, you're going to be using hand files. You're gonna get taught with hand files, everything's gonna be hand files, and that's how you're taught in dental school.

Teaser:
As long as you understand when you’re doing, you’re trying to like determine tug back and you’re trying to determine the master apical file size, for example, right? Those skills you do with hand files and they’re universal.

The most important thing is more important than the final system – Root canal without rubber dam is like doing heart surgery in the toilet. The thrill of the fill. Okay. You put your GP in and it looks as though it is to length and it doesn’t have any voids in it.

And we think, wow, this is success. Right? But the thing is, when you see a radiograph, the radiograph cannot tell you. Whether rubber dam was used, whether hypochlorite was used, whether the coronal seal was really that good, and what protocols were used in terms of this disinfection.

Jaz’s Introduction:
Basics of Endodontics. Welcome back to another Protrusive Student Series. This arm of the podcast is for students, young practitioners, those returning back to practice, or you just love listening to the podcast and you want validation. Welcome new listeners and welcome back to the returning Protruserati. We were joined with our Protrusive Student, Emma.

As she transitions into her final year of dental school, she asked all the right questions. Do you always need cuspal coverage after root canal? What kind of cuspal coverage should we go for? What determines if your root canal has actually been successful? Like we’ve all seen root canal treatments that been there for 30 years and they look questionable on the radiograph.

But there’s no pathology. Does that still count as a success? How about hand files versus rotary? Are hand files obsolete? And lastly, how significant is GP pumping to agitate your arrogance such as hypochlorite? All these questions are much more discussed in this episode.

And as of a few episodes ago, these episodes are also eligible for CPD. So if you want some easy CPD for those who are paying subscribers on the Protrusive Guidance app, don’t forget to answer the quiz. You would’ve done all the hard work of listening. You might as well get the CPD saying so by time December comes, you’re absolutely laughing. Let’s join the main interview and I’ll catch you in the outro.

Main Episode:
Emma, welcome back to the podcast, a Protrusive Student. How is your summer going? You know, I mean, I remember specifically this transition from fourth year to fifth year. And it’s really strange because like for you, it is different in a way ’cause you’ve finished your finals, right? You’ve passed.

So congratulations, congratulations once again. But it’s like you’re about to enter the final chapter. It’s a bit emotional the next round when you finish finals and then you have like, you enter the rat race. That’s an even bigger, weirder scenario. But tell us about where your headspace is at the moment.

[Emma]
I think for my final year, now that I have my exams over, I’m actually kind of excited. I think a lot of people are finding the same. I find a lot of people at Glasgow say that final year is their favorite year, because you don’t have that stress of exams. You’re more just working as a wee dentist and getting put into different outreach placements and you’re just clinical all day, every day, pretty much. So it’s just purely building on your clinical skills and getting more knowledge. So no more lectures. So I’m actually kind of excited for it. 

[Jaz]
I think that’s so cool. I’m very envious of you actually, because in most dental schools, the final year is like this crushing one. I mean, I can remember, the sheer emotions that you experienced during fourth year, but then it all culminates and I think it’s great that you managed to get out the way in fourth year, and I could really just focus. Your focus shift towards how can I get myself prepared for the real world, right? 

[Emma]
Yeah, for sure. But definitely this time last year, very nervous. But this year I’m feeling good. I’m feeling excited for it. 

[Jaz]
Good. I’m really happy, I think this is the best way because now that your focus is, how can you prepare yourself for the real world of practice? You learn differently. ‘Cause I find like with anything, most of the learning happens right towards the very end. There’s a very valuable amount of learning in any cycle that happens towards the end.

And when you have a traditional model of schooling in dental school, whereby your finals exams are in the final year, you are kind of learning to pass an exam, not learning to serve your patients better, improve your clinical skills to as much as you want to. Yes, that’s always, there is a constant theme in the background, but it’s never at the forefront. But now I think you and you guys at Glasgow get to experience this, which is wonderful.

So, amazing. And today we’re talking about Endo, right? So students’ perspective. Emma had asked me, Jaz, do you want the questions as I know, let’s go with the flow, right? Because I’m no endo specialist. I’m no endo expert. In fact, I do less endo now, like over the years I do less and less and less endo.

Actually, funny story about that, Emma. One stage I wanted to specialize and I couldn’t decide where. So when I initially entered dental school and I was like 19, I was like, I wanna do ortho, right? ‘Cause I had like braces and I had teeth align. I was like, wow, how do I bottle this up and give this to people?

So, I’m gonna do ortho. And then in dental school, ortho clinics were like the most confusing things ever. Like, what the hell’s going on? No one knew what was going on, it was madness. And I decided very quickly that, okay, ortho is probably not for me. And then my focus shifted towards endo. And I was enjoying my endo.

I won a few prizes along the way ’cause I was doing so much. I was really growing gross in Endo during dental school. And then I met a guy on the train and he saw me reading the Understanding Past Dentures book. Right? And then he sat in front of me and he noticed my textbook. And he said, yeah, you’re dental student.

I’m like, yeah, yeah, yeah. And he was talking to me. He was a dentist in the real world. Probably about 15, 20 years qualified. And he goes to me, are you sure you wanna specialize in something that’s this tall and this thin? And for some reason the bugger really, you know, that night he kept me up thinking he’s right.

Why am I specializing in something so tiny? Right? And then I decided, you know what, I’ll rule them all. ‘Cause at that stage, if you are a specialist in restorative, you can do, can be a specialist in Prostho. Perio, Endo and be all those. So I thought, okay, why not have one specialty to rule them all? And then I went to hospital training and I thought, the way I say it now is, have you seen the film Zootopia? 

[Emma]
I haven’t actually, no, I haven’t. 

[Jaz]
So good. Right. It’s such a great film, by the way. I love films like that. Anyway, in Zootopia there’s a sloth, right? You might have seen this meme or this video of this sloth just so slow. So if I was to symbolize hospital or personify hospital dentistry, it would be that sloth, right? Just so slow. And I couldn’t, my neurodivergence couldn’t keep up with that. 

So ultimately, I settled in private practice doing what I, I love what I do. Honestly, I’m a general dentist and I’ve got my niches of occlusion, TMD, restorative, and I do endo less and less, but I do enjoy every time I do it, I refer the more complex things like molar stuff, you have the Dunning Kruger effect.

You know, when I was a student, I was like, yeah, I could do molar endo. I’m willing to have a go. But with the more experience I have now, I’m noticing these gentle curves and things which you don’t notice when you’re young. And now I’m very quick to refer and get the referral pad out.

Anyway, that was a long way of saying, Endo once really interested me. Now I’m cool with it, but it’s not my area of expertise, but to a student, I know my foundations and I’d love to help clarify Endo for you and all the students listening today and to young dentists as well. 

[Emma]
Yeah, for sure. ‘Cause so it’s just some basic things and I’m at the same stage now for, like, my mom, she’s a dental nurse. She’s asking me, are you wanting to specialize X, Y, Z? And I think, well, I just have no idea. You have no idea until i’ll probably get into my VT year or my foundation year because I’m just rubbish at everything at the moment.

I’ve arbitrated about five canals at this point, so I’m just not good at anything. 

[Jaz]
That’s a minimum. You met your requirement. Wish you can graduate tomorrow and you’ve met the minimum requirement. 

[Emma]
Yeah. So I’m just rubbish at everything at the moment, everyone is. So, I have no idea of what I’m wanting to do. But I remember when I first was going to dental school, I was working in an NHS practice as a dental nurse, and I was told, with all the rotary files, but they were saying, when you go to dental school, you’re going to be using hand files, you’re gonna get taught with hand files, everything’s gonna be hand files.

And that’s how you’re taught in dental school. And then when I’ve got into dental school, I’ve never done a full canal, like with hand files and they’ve got rotary endo, which is good. But yeah. I was gonna ask what your thoughts are on rotary versus hand files, like for beginners, if that’s something that you experienced.

[Jaz]
Yeah, so we did our training on K files and incrementally bigger K files to create the right taper using the K file technique. And then we also had access to rotary as well. So I had a bit of both. And then this thing happened whereby you qualify and it was this really terrible thing, Emma, whereby if it was a public system patient, they’d get one, like a hand file system.

And then if it was a private patient, you’d get, like, you get to use the fancy ones, which are more expensive, which I get because if there’s a significant cost out later to practice for using rotary. But I didn’t wanna practice this way in terms of differentiating. I want to do the best I can, which is one of the reasons I went to private practice.

‘Cause I just want to do the way I was trained and essentially like we know that the hand file system works, it’s just not as efficient, but it’s great to be held to ’cause so much tactile feedback is involved in Endo and to have those skills, being confident with the K files and Hedstrom files and the basics of it.

As long as you understand when you’re doing, you’re trying to like determine tug back and you’re trying to determine the master apical file size, for example, right? Those skills you do with hand files and they’re universal. So I think when you’re learning whatever training comes your way is great, but know that sometimes choosing the rotary path, and if you are irresponsible with using rotary and you do what we call a strip perforation.

So for example, you’re kind of going through the route ’cause you’ve been too aggressive or you cause ledges or you cause file separation, that kinda stuff because you’ve been too aggressive, then that needs to be balanced out with being a safe beginner, but just going a bit slowly with K file.

So either is good. The most important thing is more important than the file system is the disinfection. Are you doing rubber dam isolation? Are you using hypochlorite? Which is the best arrogant that we know at this moment in time? So those are more important than the file system. And as you become more confident, then you’ll be able to be able to choose, okay, this one I’m gonna do hand file this, I’m gonna do rotary. But more often than not, you will be doing rotary in the real world. 

[Emma]
Yeah. Yeah. Which is good ’cause we’ve got RECIPROC® in the dental school, which is good. But yeah, when we were doing clinical skills, I think we maybe done one canal, which was purely hand files. But yeah, every time I’ve been in clinic, it’s been rotary, which is good, but I just don’t, yeah, I don’t know if I’m missing that sort of experience with the hand files. But, we’ll see. We’ll see. 

[Jaz]
And something I didn’t appreciate so much is a taper of your file. So imagine you’re doing a lower incisor and you are using that same RECIPROC® system that you would’ve used for an upper molar. And that lower incisor has two canals, like a buccal and a lingual.

Then imagine how much tooth structure you’re removing to accommodate that file and the taper. So sometimes there is a place for knowing about different taper of different files, different dimensions, and having the K file, the humble K file, which is 2% taper, and to be able to navigate that is, is an important skill and thinking about taper is really important.

But you’re just gonna say, so the premium, the student notes you’re gonna submit as part of this episode. Just to remind everyone as part of this Protrusive Student series, Emma prepares these notes. Every episode we do with Emma, she prepares these notes. They are available to access in the Crush Your Exam section of the Protrusive Guidance app.

We do a manual approval process. So, if you haven’t heard back from us, it’s because we’re still kind of figuring out, are you a dentist? Are you a dentist student? Because we don’t want any members of the public. This is safe space. Please, Emma tat take it away with the notes that you’ve prepared.

[Emma]
Yeah. So when I first started out doing endodontic treatments at dental school, which I’m still very early on in doing a dental school. I find it very hard to know what steps to take things in. So myself and a few other students, we would always just have a little notebook in front of us with what steps, like your steps of your root canal treatment, what files you should generally start off with, what things you need to get out before you start.

Because a lot of the time in Glasgow, we are nursing for each other. And the nurses are amazing. They will help you set up if they have time, but a lot of the time you’re doing it yourself, so you’re getting all your equipment. So I just had sort of everything that I need and just a basic step by step.

So I’ve sort of put that into a document and also just explaining a bit more about why you’re doing the things that you’re doing, not so much just like what you’re doing with it, if that makes sense. Because I think for Endo treatment for me, I knew what I was doing, but sometimes not why I’m doing it.

So I’ve put in step by step by step and just a little bit more about why you’re doing what you’re doing as well. So we’ll link those in this episode as well. So hopefully people can just have that at the side printed off if they need it or make their own wee version. And that’s what really helped me for Endo as well.

[Jaz]
It’s wonderful you took the words outta my mouth because I was already gonna say, ah, but more important than the protocol and what you do is why you do it. Because once you understand why you do it, you know? Any scenario that comes your way, you’ll be able to handle. ‘Cause sometimes, you can’t do a cookie cutter approach sometimes, but when you understand why you do something.

Then you get it. So I love the fact that you have not only the protocol, but why you do each step. ‘Cause that is, like, for example, one thing that used to give me a lot of stress in the past was, if I was using panavia, I love panavia now, but in the early days of using panavia, in dental school like.

Having the laminated sheet, like, wait, what do you do step by step? Like, I need to know this, like, it was stressful for me. It was just like a stupid thing. It was stressful for me, right. To know, make sure we follow the steps to a T. But now when you understand the biochemistry of how these cements work, then you are able to, you just know the flow because of you understand why each step is necessary.

So why you use the ceramic primer stage at the stage you do, why you use the tooth primer in that sequence. And so once you understand why and that you’ve nailed it, so brilliant, we’ll be able to share that it’s only available on Protrusive Guidance. So your first question was about rotary versus K files, and the answer is it’s all good, but the future is rotary.

Just be careful with taper and being able to do the critical steps like a patency filing. You know what patency filing is? 

[Emma]
Yeah, is patency, I get patency and recapitulation mixed up. But is patency file in just taking like our size 10, straight down and taking it just beyond the apex to make sure it’s free of debris?

[Jaz]
Yeah. Yeah. And then recapitulation is like in between changes of files in between, make sure that it’s still not clogged, basically. Right. So that’s something you do with hand files. The other really important thing with hand files is deciding what is your master apical file size.

And so you check, okay, are you at a 30 or a 35 K file, and then you help, that information helps you to correlate what kind of a GP cone you’re gonna finish with and depending on which rotary system you’re using and that kind of stuff. So these are really important, um, skills.

So one top tip is, let’s say you get a blue size 30 K file. So this is like the ISO color system. You take it to your length. Okay. How would you check whether your master apical file is a 30 or it’s 25 or it’s 35. What have you been taught to determine? 

[Emma]
Would you check if for like tug back to see if it fits well at the apical region?

[Jaz]
Okay. So let’s say the canal is 20 millimeters. You take this 30 to 20 millimeters, and then you are checking for tug back, right? Is that what you, so you’re checking for the tug back. See, that’s good, but the issue is, yes, you might have tug back ’cause it that friction’s created, but what if you just try to just poke it through a little bit and it just went through?

[Emma]
Yeah, so using your- 

[Jaz]
So tug back is more used for GP Cone as well, like make sure that your GP cone has a bit of tug back. The way Ian Harris taught me, years ago was you take your file, you put to length, and then it’s just like a tiny little flick. You almost like flick it and see does it actually go beyond?

Because it goes beyond, you know that you need to actually go for a bigger ’cause actually, it’s going beyond your apex or beyond your working length that you determined. So therefore you need to go for the 35 and can that, A go to length, and when it does, then B, does it stop there and it doesn’t go anymore. That for me is, okay, this is my master apical file size. Does that make sense? 

[Emma]
Yeah. So what happens if you flick it and it does go? Does that mean you just need a bigger size? 

[Jaz]
Yeah. Yeah. You need something to stop. So you want something that’s big enough, that’s small enough to reach there all the way to your working length, but not so small that it’s gonna go through.

[Emma]
Okay. Okay, that makes sense. Yeah. One question that I did have for you, and not to skip right towards the end, but about irrigation and manual dynamic irrigation. And we have a certain protocol in Glasgow, but I just want to know if that’s like a universal protocol or what you do in your practice. Or if Glasgows just does something different or if everyone does the same.

[Jaz]
You know, sometimes there’s semantics, like, you know, how they change, like scale and polish to PNPR and all that kind of stuff. Like, yeah, sometimes just semantics. So, according to the best of your knowledge, what’s that term you use again? 

[Emma]
Manual dynamic irrigation. 

[Jaz]
Okay. So what is manual dynamic irrigation to you? And I’ll probably say is GP pumping or something, but what is it to you? 

[Emma]
Yeah, like agitating the irrigant inside the canal just to- 

[Jaz]
How do you do that? What techniques have you been shown? 

[Emma]
So we’ve been shown like using your GP cone, but we don’t have them in Glasgow. Not for the students anyway. But you can get like specific, I dunno what they would be called. 

[Jaz]
Agitation tips, like ultrasonic tips and that kind of stuff too. 

[Emma]
Yeah, the ultrasonic point. 

[Jaz]
So, totally. This has got very good evidence base in terms of being effective and it’s amazing how much cleaner your canal looks by using this. So endodontists are very pro. Ultrasonic agitation of your I irrigation protocol. So good.

So at the very least, I think it’s a wonderful thing to do with GP pumping. You can call it manual dynamic irrigation, but essentially you take , let’s say it’s an F1, F2, or whatever, a GP cone, that’s your master one, and then you’re kind of taking it just shy of the length and you are just agitating up and down, up and down, up and down to, in the hope that, you try and get the best of the hypochlorite into all the nooks and crannies and it flows to get all those hidden bugs and disrupt the biofilm.

Now here’s something that, the same company that makes this, the parent company, the same company that makes the, I think it’s called, again, I’m not gonna say this brand name again. You DM me on Instagram and I’ll tell you these brand names. It’s used in canals and it goes, it vibrates. So it’s not like proper old sonic agitation, but it’s a tip that kind of looks like a plastic paper point, right? And it goes in the canal and just like it vibrates and it does this dynamic activation for you.

So the way you do it, instead of paying hundreds of pounds for this fancy unit that you put these tips on, you can actually buy this cheap, like super cheap one that we use for interdental cleaning for patients. You take the tip off and then you can actually use the tips that are designated for this activation of the hypochlorite.

So again, I’m just cautious ’cause we’ve had a great run on Protrusive so far. I don’t want this to be the end of Protrusive by me revealing these trade secrets that get in trouble. But if you wanna know exactly which ones DM me on Insta or message me on, or DM me on Protrusive Guidance, I’ll tell you exactly which ones to get.

But it’s pretty much common knowledge. And so this is a great and cheap way to do it. But the cheapest and most universal way, no matter what country you’re in, is a GP cone of the correct diameter, just slightly shy of the apex and you up and down, up and down to give it that manual activation.

[Emma]
Okay. Okay. I’ve never actually seen anyone in practice use anything but just the GP cones. I dunno if that’s a new thing or I- 

[Jaz]
But have you shadowed a endodontist? Specialist? 

[Emma]
No. 

[Jaz]
When you do, like, they are like playing a different ball game altogether. Like they are using all the tools and toys and scope and alternate agitation and they’re so slick. They’re so efficient and slick. It’s like they can do the ice closed. It’s really like poetry and motion seeing ended onto seeing good on end onto work is poetry in motion. But yeah, they use, there’s like almost like gold colored ultrasonic tip, they dip it into the canal, they switch it on. And you see the bubbles form and then suddenly it goes murky. Yeah. And then it goes clear. Like it’s beautiful. 

[Emma]
Yeah. And we’ve got, I think he’s an endodontic specialist. He’s only been at Glasgow I think the last year or so. And whenever he’s on restorative main clinic for Glasgow, you want him, if you’ve got a root canal because he says to the nurses, oh, go and get my microscope.

Go and get my microscope. I’ve never been able to use it. ‘Cause I’ve never had him on clinic for an endo patient that’s actually turned up. But it’s good he gets all the tools out and gets everything from his own clinic and lets us have a shot, which is good. 

[Jaz]
That’s awesome. You want tutors like that. That’s lovely. 

[Emma]
Yeah, it is. Good. But again, with the irrigation protocol, is it always like we are taught to do. I think it’s like at least 30 mil, at least 10 minutes before obturation in each canal, irrigating with sodium hypochlorite, then your 17% EDTA, and then a final flush with sodium hypochlorite. Is that pretty standard to you? 

[Jaz]
Yeah, that’s pretty standard to use. What percentage are you using in dental school? ‘Cause we are using like 0.5%, which is quite weak in dental school because it’s so caustic and you can get it on patient’s clothes and cause you know, extrusion and when you are learning they just want to play it safe.

So like the efficacy really improves. The stronger you go beyond 3% is good. Some endodontists use 5.25%, but obviously at that level of concentration for students to use. I understand why they have reservations about that. So, do you know, what concentration are you using? 

[Emma]
We use the 3%. 

[Jaz]
Okay. That mean that’s good stuff. That’s a proprietary, hypochlorite. That’s very good. Yeah, very effective, very dangerous as well. So you gotta be careful. Has anyone got any hypochlorite on a patient’s clothes or something? 

[Emma]
No, not that I know of. Not yet anyway, but there are, you know, if you go round and you’ve got your thumb on the plunger, you’ll get shouted at.

[Jaz]
So yeah. Great point there. Never have your thumb on the plunge. Yeah. It should be your index finger. Is that who you even taught? 

[Emma]
Yeah, your index finger. Yeah, so we’d get around for that one. But in our preclinical skills class, we did a lot of endodontics as well and a lot of emphasis on safely using hypochlorite and injuries and things. And I’ve actually seen one in practice as well, which was not good. 

[Jaz]
Yeah. Patients come in and they look really bruised and very swollen and there’s an episode we did called the 10, I think the 10 Commandments or something. And one of the scenarios we tackle was a hypochlorite injury.

So we’ll make sure we link that episode to, for everyone to listen to. ‘Cause so many great scenarios we covered in that podcast. One of them was a hypochlorite injury and how to manage it. But yeah, you gotta, basically, you gotta be careful, but you guys are using really good stuff.

So the benefit of hypochlorite is it removes, it kills the bacteria, but it also dissolves tissue. No other irrigant. Yeah. Does both so well. And this is a highly researched topic. They’re really trying to find the one arrogant solution that rules a more kind of thing, but hypocrite is still king. And people always say like, rubber dam, right?

Rubber dam is like, we haven’t talked about it, but doing root canal without rubber dam is like doing heart surgery in a toilet. Like literally that was the way it was explained to me as a student. And I think it’s so, so, so key. Now, some people say that I have good isolation, I use cotton rolls, and I don’t, there’s no chance of any saliva getting in under my watch.

‘Cause we’ve got high volume suction, we’ve got cotton rolls, but I’m like, okay, fine. There’s no saliva, which is full of bacteria going in the canal. Well done. But surely, surely, surely, surely you’re not using 3% plus hypochlorite on that patient, therefore. The whole point of rubber dam isolation is to facilitate you to use these strong agents so that you can, if you are using corsodyl mouthwash for Pete’s sake, if you’re using corsodyl mouthwash, that’s doing nothing right.

And no wonder you can get away without using Rubber Dam. And so yeah, it’s great that you’re using the correct irrigant, Hypochlorite at a wonderful percentage. You guys heat it. Do you guys like heat the hypochlorite? 

[Emma]
No, no. 

[Jaz]
So that’s another technique you can do. You can heat hypochlorite to get even more effectiveness of your hypochlorite. And then do you know that the sort of rationale and the mechanism of action of a 17%? 

[Emma]
So EDTA is like a chelating agent, and so like all the smear layer that you’ve created from your canal preparation, it helps to sort of remove that smear layer so that you can get in contact with those tubules really well.

[Jaz]
Yeah. Opens the tubules, which is why you then do a final flushed hypochlorite. ‘Cause now you’ve opened the tubules. You want the hypochlorite to be able to go in and well the endodontists, because they use a warm vertical compassion, they use like hydraulic pressure with this hot GP, you have the best chance of the GP going into these accessory canals and into the tubules. And so that’s why we use that. So it’s a winning combination.

There’s a really good paper. I’m gonna recommend everyone checks out. There’s a really good paper by Paula Ng. Paula Ng. It’s a fairly classic paper and it looks at like loads of root canals, and they try and find out which elements of the protocol significantly influence the success rate. Do you know about this paper? 

[Emma]
I don’t think so. 

[Jaz]
So like for example, having a sinus tracted at the beginning, there’s a certain percentage, I forget at one point I used to know, but having a sinus tract at the beginning, it reduces your endodontic prognosis by 20%, just by the presence of it basically.

But then when you heal it, then that changes your prognosis further. If you use EDTA, then it improves your success rate by 10% or something. I think it was 10%. But like there’s various factors which all add up. And that Paula Ng paper really does a wonderful job of summarizing it.

[Emma]
And just on the back of that, just as a gossip, I suppose I remember I did a locum in a practice, I won’t say where or who, but they were using Milton like Baby Milton which I was like, subpar. But you know, I’m just here for one day. Like, it’s not like I worked there permanently. They were using Milton and Chlorhexidine for their root canals.

There was no rubber damage sight. And when they were taking a, like into appointment, radiograph, they put a clamp on. They put a clamp on the. And then took the radiograph and I had no idea. 

[Jaz]
So you know why they did that? You know why they did that? 

[Emma]
Yeah. It wasn’t until I spoke to someone else about it, I was like, why are they doing that? Just so that it looks like they had rubber dam on, on the radiograph. 

[Jaz]
Exactly. 

[Emma]
It’s so bad. It’s so bad. 

[Jaz]
A hundred percent. So this is you, this is the secrets of the things that happened. So how much endodontics is happened in the real world. Like in that way. It’s a shame.

And so here’s a crazy thing, Emma, right? I was in India. I was on this course in India, and next door there was an endo course. Because this is when I lived in Singapore, right? And I thought, wow, it’s great value to go to India while I’m in Singapore. I get to visit India, but also at the same time go to some CPD there, which was like amazing value.

But then the next door they were treating, they were literally treating an endo students. There was like seven dentists there learning endo dentists, right? Not a rubber dam in sight. 

[Emma]
Really? Wow. 

[Jaz]
And, so I’ve just googled Milton’s solution in terms of percentage. So, typically 1%. So it’s not too bad considering, 0.5% what we use at dental school.

Okay. So the fact that they’re using a form of hypochlorite is better than using corsodyl, right? So fine. But, rubber dam, it’s a necessary because saliva is full of bacteria. But the naughtiest thing here basically is the use of the clamp for the radiograph so that it basically medical legally that I use rubber dam, look at the clump like I use rubber dam kind of thing.

So it’s naughty and I think the kind of people who listen to this podcast and who engage and who comment and stuff, we are so far away from that, that for some of us, it’d be like, what? Really? Do people do that? Because I like to think that we are a collective of the most forward thinking and people we generally want the best, our patient.

Like, would you do that on your family member? You want your endo, you want this endo to succeed. The funny thing is, endo a bit like perio. The host response is the real winner here, and our job at endodontics is to disinfect. We can never sterilize a canal. We want to disinfect and create the environment to allow the body to heal, which is why I see in my population of 60 plus patients, which I have so many of. I see these silver points. Have you seen the Silver Points before? 

[Emma]
Silver Points. 

[Jaz]
So before they used to use gutta-percha, GP, there was like these silver points in canals, right? And it’s like they have this like classic look like a, they literally look a super radio opaque point in the canal and they’re like super short.

Yeah, they’re like really short the apex usually. And you think, and there’s no infection around the tooth like there, so this quote unquote dodgy root canal has been there. Right, and sometimes you see something that’s poorly obst, it’s single file plenty. It’s like floating in the canal space, but there’s no infection, right?

So you might just by using saline as irrigation, by using, by just sticking a couple of files in there, sticking a GP point cone in there. Maybe I’m just postulating, maybe you will get 50 to 60% success rate just by closing it up, giving a coronal seal, and you might get 60% at five, 10 years. Right?

Still, that’s a lot of failure. But when you are trying to aim for the success rate, the endodontics does thankfully enjoy, right? Which is 90, 95% plus done well and in life. That’s where we want to be at. That’s what we wanna aim for. And that’s those little things, which are the big things, right? By rubber dam isolation, doing it properly, not just for the radiograph, right?

Using the correct solution. And just, if you get the basics right, it’s like Pareto’s principle, right? 80% of your effect comes from 20% of endodontics. So 20% of endodontics that have the 80% effect is rubber dam isolation. Choosing hypochlorite and respecting the structure of tooth and not being overzealous with being conservative. If you do three things, then that is a pato principle, endodontics, you get the 80% success by just doing those three things. 

[Emma]
Yeah. So if you are doing these three things. What are you looking for for a success of root canal treatment? What do you class as a success? What hallmarks are you looking for?

[Jaz]
I love this question, right? Because classically, when I was at your stage and a young dentist, we have this perception that it should look sexy on the radiograph. So at your stage, I was looking at the radiograph, right? The thrill of the fill. Okay. You put your GP in and it looks as though it is to length and it doesn’t have any voids in it.

And we think, wow, this is a success. Right? But the thing is, when you see a radiograph, the radiograph cannot tell you whether rubber dam was used, whether hypochlorite was used, whether the coronal seal was really that good and what protocols were used in terms of this disinfection. So yes, the radiograph is one factor, and if you look at the European guidelines.

The GP cone obturation should be within two millimeters of the radiographic apex. I believe I need to revisit these guidelines again. And then there should be no unfilled canal beyond the gp. Lemme say again. There should be no unfilled canal beyond the gp, and that’s a really good one to look for.

But again, these are just a factor, right, which don’t tell you the full story. So for me, the success is if there was a sinus tract present that that sinus tract, which for the students who are early in their career, it’s like having a pimple on your gum and the source of the infection of the pimple. Have you seen the sinus tract before? Emma? 

[Emma]
Only like as a nurse. I’ve never seen one on a patient myself. 

[Jaz]
So sometimes you can actually, stick your GP cone into the sinus tract. Let’s say the sinus tract is between two premolars and you don’t know which pre-, they’re both premolars look a bit dodgy, and you think, hmm, which one’s the infected one? You can put a thin gp point in there, and then until you feel a stop, and then you take a radiograph and it’ll show you on the radiograph, which is the culprit. Okay? So anyway. Sinus tract. If the sinus tract is gone, that’s a success.

If it’s no longer TTP, i.e., tendered to percussion, that is a success. If there was any peri-apical pathology that is now healing. Okay, so at six month mark, you’re seeing some healing and the patient has no discomfort from it. These are all factors we look at. And so there are success parameters and also there’s survival, which is fascinating, right?

Success versus survival. A tooth could be like, still technically have some elements that we would think, oh, there’s a failure. There’s still unfilled canal. There’s still a bit of radiolucency there, but it’s still functioning in the patient’s mouth. The survival data is also very interesting ’cause it’s causing patient no issues at all.

They’re still chewing with it. We still see this black area and we think it’s a failure, so we’ve gotta get clear what does it look like for us? And I think it’s good to know both. But ultimately, is the tooth serving the patient in some way and the patient’s able to, let’s say, go on holiday and not worry about this tooth.

I have some patients who they feel like they need to go abroad with antibiotics, otherwise they worry this tooth will flare up. That’s not success. Success is being able to go in holiday and not having to worry about that tooth. And if it’s something arises, it’s like a total shock. That to me is success.

[Emma]
Yeah. Because we’re taught all about these hallmarks to look for on a radiograph pre and six months down the line, you know? But if it’s still sore, then how can that be a success? There’s different, what did you say there? It was success and to survival. 

[Jaz]
Survival. That’s right. So the success is a bit more strict criteria, right? And where survival is like, is it in the mouth, is it contributing to the patient’s function, and without causing any major symptoms or not, like something that’s causing active symptoms to the patient. 

[Emma]
And then if you have a situation where you’ve provided a root canal treatment on a tooth that was symptomatic, how do you approach the conversation with the patient about having a cuspal coverage restoration after that?

Like, how long do you wait until providing a crown? Because ideally, I know you want to do it within a few weeks, if you can. Then there’s money involved. And then if the root canal fails, how do you approach that? That’s a tricky one. 

[Jaz]
This is such a beautiful question. I think this will be the last one to tackle then today, but this is such a great question. Okay, so let’s end on the high. This is a timeless debate, right? What point do you go for your cuspal coverage? So I think first we need to go back a bit and decide when do we need cuspal coverage and when do we not? So, in a few instances, for example, if it’s an upper incisor that had just like a third bit of trauma, it’s still structurally you could just do a class four and fix it, for example.

So in a medium sized class four, and then when you do your access cavity, palatally and it says, one canal and you’re able to fill it, you don’t need cuspal coverage very often. You don’t need to crown that tooth just ’cause you had root count treatment. If there’s enough tooth structure. When it comes to molars and pre-molars, if it’s just a class one.

You still got good rigidity and two structure remaining, and for some reason it was like a deep class one caries and the marginal ridges are intact in most patients, not all, ’cause some patients are very high risk or they’ve got existing crack line stuff. In most patients you don’t need cuspal coverage.

It’s okay, but to be honest with you, the vast majority of cases, they’re already like huge MOD amalgams or a do caries that would probably benefit from cuspal coverage. So vast majority of time we need cuspal coverage because there’s marginal ridges. The strength of tooth really comes from marginal ridges and quite often the other reason actually, do you know the other reason why a lot of root filled teeth will benefit from cuspal coverage? We talked structural loss is one, but there’s one really key thing that I think is underrated and needs to be talked about more. 

[Emma]
I suppose, like the tooth being brittle, that’s the same as the first point, isn’t it? 

[Jaz]
Yeah. So we brittle, maybe the arrogance make the tooth brittle, but actually the crux of it is that there’s a thinner, weaker tooth structure. Because once you strip back the tooth and make it naked and get rid of all the restorations. And now you’ve made a access and you’ve canal, you’ve widened the canal. If you look at how much tooth structure is remaining, it can flex and it can break, so it’s weaker. So that’s one structural. Yeah, but there’s one more.

[Emma]
Is it just to prevent reinfection? 

[Jaz]
It’s a coronal seal. But, what if you did a really well bonded composite and got a coronal seal. I think sometimes indirect restorations can help. I get that, but actually the answer is proprioception. A third of your tooth  proprioception is provided by the pulp.

The PDL does the heavy lifting, but the pulp is important. So the best analogy, the best way I learned this again, Pascal Magne taught me this is imagine you have your upper right first premolar, okay? And then you are gonna bite in your fingernail, okay? And you bite, bite, bite, bite, bite, okay? And very soon you’d feel like pain.

You’ve overloaded your tooth. That’s a  proprioception from your PDL and from your pulp. If that tooth is root filled, you’re gonna invite right, bite your, are suddenly able to load it more before it talks back to you. Says, hold up a minute. Okay, so this is a recipe for disaster. ‘Cause now you have a weaker structure that, that needs more load to give some sort of reaction.

And therefore this is asking for it to be cracked and broken. Yes, cuspal coverage very often is needed. And so at the very least, I like to do a pre-endodontic buildup. So I used to back in the day not appreciate the stage so much and I used to like drill through old amalgams to try and find the canals and I’d leave the amalgam there and, but actually what you need to do first.

Strip back the entire tooth, make it naked, go, go, go all the way, like remove everything, then caries removal, then put a major span on, get your pre endodontic seal or pre-endodontics restoration. There’s a big block of composite. And then you’re gonna do your endo through that. This is the gold standard that I’ve learned now.

And at that point you can actually bring the cusp down and then overlay. Now you have a direct cuspal coverage, right? But from your composite, you’ve now also built a coronal seal. You’ve got rid of the old tooth structure and you’ve made those cusps shorter and fat, which is less flexing and made it stronger.

And then now, even if the patient does disappear for about three months or a year or whatever, at least now you’re less worried because you haven’t got crown on there. Whatever. You should still probably in vast majority of cases to meet the aesthetic demand and function demands, probably upgrade to a lithium disilica or a zirconia or whatever you might go, okay.

But at least that’s better than leaving the cusp as they were. At least with that composite, that cuspal coverage composite, you give that to some protection while your decision making about what, which indirect restoration to provide. And the other, it answers the other question of how soon should you do it?

Well, as soon as possible, you need to provide the coronal seal. Yeah, as soon as possible where indicated you get to give some cuspal coverage. So nowadays with composite, you don’t have to wait to give those two benefits. You can always upgrade to indirect in the future. And then you said about, what if the root canal fails, well, if done well, root canal does enjoy 90% plus success rates.

So this is something that you tell the patient that, look, you know, this is the success rate of working to, if it doesn’t work for you, then it’s a shame we’ll have to extract that tooth, but it’s still better than removing the tooth and going for an implant in the vast majority of scenarios.

[Emma]
Yeah. So I guess again, like all just comes back to consent and I know you like to ask your patients, like how much of a gambler they are and quote them all these success rates and then I suppose as long as you’ve told them about all the risks and everything- 

[Jaz]
So let’s recap that, right. If you’re unsure and you’re not sure which way to go, and the patient’s ing in our ring, you say to the patient, look, if you spend a significant amount of money, let’s say a third or up to a half of an implant. ‘Cause it varies in every country. So let’s talk in those terms, right?

It’s a fraction of an implant, but a sizable fraction of an implant on root canal, a pre-endodontic restoration, and a crown in the future. And it fails. Which is less likely to happen by say, so more than likely it’ll work. But if this does happen, okay, would you be like, well, at least I’m glad I tried and now I’ll save up for an implant and I can arrange this.

Or would you really regret that? Ah, I wish, I really, really wish I went for an implant and not this. Because I would tell them that, look, if it was my family member, then having your tooth has a value even to keep a tooth on five, 10 years. Yeah. There’s value in that. Then going straight for an implant.

But as long as the patient understands that it’s their risk to own, how would they feel? Imagine that it did fail. How would they feel if they feel like, you know what? I’m glad I gave it a shot and I tried to keep it, and I was a bit, a little bit unlucky in that regard, then they’re a bit more understanding that way.

[Emma]
Yeah, that’s fair enough. And I know you said that was the last question, but do you have a different consent form for root canal treatment? 

[Jaz]
Yes, absolutely. Yeah, the endodontist has his own one. We talk about file separation. We talk about all those things, but like with everything, everything has to be customized, so you should be able to draw on the consent form and stuff.

And mine’s nothing fancy. It’s like a template handed down for me from wherever. It’s the nothing fancy. ChatGPT can write you one in, 10 seconds, right? Nowadays. So I don’t think it’s a consent form. It’s the way you communicate and the way you customize that consent for that too. Like there’s no like if you have a upper central incisor root canal, and you are dealing with a beautifully straight wide canal, okay, I’m sorry, but if that file separates in that canal, right? Yes, it’s in your consent form, but that’s negligent. A file should not be breaking in that tooth. That is silly. Yeah, it should not be happening.

All right. If it’s a curved, lower molar, totally. You need to emphasize that more on that form. That, Hey, for this? Hey, patient, you are high risk of this because you’ve got a curve. Here’s what I’m gonna do to mitigate it. But you need to understand that actually it’s your tooth that’s curved.

Okay? Whereas in that single central, with a beautiful straight one, it’s very unlikely that this is gonna break because it’s a nice straight canal. So it’s very, extremely rare and unlikely. So it needs to be made bespoke. They need to understand which risks are real for them, and which ones are just on paper. Academic. 

[Emma]
Okay. That makes sense. Yeah. 

[Jaz]
Alright, great. Emma, thanks for asking. I’m really impressed with your insights. Some of those questions were really good. I hope you feel a little bit happier with that topic overall. 

[Emma]
Yeah, yeah, that was good. Yeah. Some good tips and tricks in there as usual.

[Jaz]
I think the theme of this episode wasn’t so much technical then use this file then how you move a ledge and stuff. ‘Cause I think that’s something that you can only learn hands on. But I think we approach it from a bigger picture perspective for Endo, which I think is helpful when you’re starting out and you are revisiting.

[Emma]
Yeah. And I think that’s why, for the notes, I focused more on actually doing the endo and that side of things. And today was just a general, some questions that I had. Really. 

[Jaz]
Good. I mean, you asked all the good questions about the role of irrigation, the sequence and the necessity for cuspal coverage. The role of rotary K file, all that kind of stuff. So I think your questions were excellent. What do you think we should cover in next month’s student episode? 

[Emma]
So next month I had always wanted to do a bit of a medical history episode, more just like key drugs in dentistry. I think this is more relevant maybe for people who want a refresher, but like very early on in dental school, maybe when you’re starting to see your first patients.

I remember being so afraid to take a medical history and do a systems inquiry or do I do this approach? So I think talking about the key components of a thorough medical history and talking about maybe some key drugs in dentistry as well. 

[Jaz]
Okay, let’s do it. But I’ll tell you that right now. You probably have spoken to so many dentists you work with some of these things like medical history, like you’re so hot on it when you’re a student. When you come in the real world. Okay, actually, you’re gonna have more knowledge than me. All right? And so we’re gonna do a role reversal. You are gonna be schooling me about medical histories.

Okay. But I’ll give you my flavor and perspective experiences, but I have enough humility to appreciate that. You probably know more medical histories than I do, Emma. Okay. And so I’m excited to learn from you. So let’s, look forward to that one. 

[Emma]
Yeah. Perfect. Okay. We’ll do that.

[Jaz]
Thank you so much, Emma. 

[Emma]
Thank you. 

Jaz’s Outro:
Well, there we have it guys. Thank you so much for listening all the way to the end. Once again. How good of a job is Emma doing? I want some love for Emma. So whether you’re watching this on Protrusive Guidance or YouTube or listing on Spotify, find us on Instagram if you want.

And just send some love to Emma. I think she’s doing a wonderful job of asking the right questions. And I hope you are enjoying this Protrusive Student series. Remember, we do have a crush your exam section in the app. Once you gain access to the app, just message Mari, MARI, Mari Benitez, she’s our CPD Queen.

She also is the gatekeeper of the students’ freebies. So be sure to message Mari. The website, of course, is protrusive.app. That’s protrusive.app, and it’ll be great to see you on the platform. It’s just magical to have the community of the nicest and geekiest dentist in the world. One of our members, Hannah, from the States, she recently said that she’s making it like a routine to spend half an hour to 40 minutes a day on the app, which is so much better than doom scrolling on Instagram and TikTok, and she’s noticed her own words.

She’s noticed a significant improvement in a quality of a dentistry and an enjoyment of dentistry. Now, that just means everything to us. So if you’re not already on the app, check it out, www.protrusive.app. Otherwise, I’ll catch you same time, same place next week. Bye for now.

How should you  gain consent for ELECTIVE treatments?

Is selling in dentistry something to avoid, or an essential part of patient care?

How much does emotional intelligence really matter for your success and happiness?

Dr. Colin Campbell joins for a powerful episode that dives into consent, sales, and the balance between profit and ethics in dentistry. He also unpacks the huge role of emotional intelligence—not just in clinical practice, but in life.

Expect real talk, strong opinions, and communication gems that can reshape the way you connect with patients and approach your career.

Protrusive Dental Pearl: Read (or listen to) the book Let Them by Mel Robbins — a powerful reminder to take control of your own life and emotions instead of letting outside events dictate them.

Need to Read it? Check out the Full Episode Transcript below!

Takeaways

HIghlights of this episode:

✨ Transform Your Dentistry ✨

🦷 Campbell Clinic – world-class private care in Nottingham.

📚 Campbell Academy – ethical implant training from beginner to expert.

✍️ Colin Campbell Blog – daily insights to challenge & inspire.

If you liked this episode, check out ‘How to Win at Life and Succeed in Dentistry’ with Richard Porter

#PDPMainEpisodes #CareerDevelopment #Communication #BestofProtrusive

This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance. 

This episode meets GDC Outcomes A and D

AGD Subject Code: 550 – Practice Management and Human Relations

Aim: To explore the ethical, emotional, and practical aspects of private dentistry, with a focus on gaining valid consent, balancing profit with ethics.

Dentists will be able to –

2. Recognize the ethical challenges of elective treatments.

3. Outline strategies for building long-term career satisfaction and avoiding burnout.

Teaser: When you think about the number they have per hour, less than five is normal, right? Less than five of these breath holds is normal. Between five and 15 is your mild category. 15 to 30 is moderate, and above 30 is severe. You see patients that have what we call an AHI Apnea-Hypopnea Index of 60, and sometimes these breath holds can be 30 seconds.

Teaser:
Profit is oxygen for my business. Get that? It’s essential for life, but it’s not the meaning of life. I do not wake up in the morning going, oh, I’m gonna get some oxygen today, but if I don’t breathe, I’m dead. Right? So we need to-

I don’t think that’s the question. I think the question is what would I do if you or my wife, brother, mother, daughter, son? And so I’d say what you want me to do is use the experience that I have to pigeonhole you as a member of my family.

The world consent is a relationship management. You can’t treat your patient as if they were you. You have to treat them as if they are them. I would like to say to the guys is if you want to be really successful in the industry, both in terms of financially and in terms of the respect you get from your peers and in terms of the satisfaction you get from your job, try and-

Jaz’s Introduction:
Gaining consent for elective treatments, selling in dentistry, the monumental role of emotional intelligence for your happiness in your life and your career. Hello, Protruserati. I’m Jaz Gulati and thank you for tuning in to what I think will be a Protrusive Hall of Famer. This episode gave me vibes of Richard Porter.

The OGs will remember way back when we did an episode called How to Win at Life and Succeed in Dentistry, and we talked a lot about emotional intelligence in that episode. Brilliant episode Richard Porter. Do go back in the archives and check it out, and this episode builds so nicely on that. Dr. Colin Campbell is absolutely scintillating inspiring.

I’m so excited for you to be able to listen and watch this from wherever you’re tuning into. Thank you so much. There are some real great gems on communication and some absolute real talk, controversial, real talk from Colin, which I absolutely loved. So if you’re doing a lot of composite veneers, you may wish to skip this episode. Colin does not mince his words.

Dental Pearl
Now this is a PDP episode, so I owe you a Protrusive Dental pearl. And you know what, I might have actually given you this pearl before. Like recently, maybe I perhaps gave it in a recent episode, but it’s in my head and it’s so relevant for this episode, right? This audiobook, I listen to, “Let them.” Now if you are even slightly into audible books or had a look at which books are on sale right now.

This book Let Them is everywhere. And for good reason, I listen to an audiobook and Mel Robbins, honestly, this audiobook is so, so brilliantly done. You literally feel like she’s talking to you. It’s so easy to listen to, so conversational and my friends, I think this book will change your life. I’m desperately pleading my wife to read this book and she won’t because she doesn’t read.

So as per the philosophy of this book. Let her, let her not read, let her not gain from this book, but let me drip feed the lessons to her. Let me induce a degree of osmosis, informational osmosis, and take control of the situation. So you kind of get a flavor of this book already. I’ll put the link in the show notes.

This book is all about taking control of your life and not letting what happens around you to control you and your emotions. It’s about you taking control of your life. So once again, Let Them by Mel Robbins. I put the link in the show notes. And now let’s check out this absolutely cracking episode with Colin Campbell.

Main Episode
Dr. Colin Campbell, welcome to the Protrusive Dental Podcast. How are you, my friend? 

[Colin]
I’m very well, and I’m very excited to be here. Actually. 

[Jaz]
You’re the one who’s super excited. 

[Colin]
No, no, no. I just spent a few minutes, when I was preparing just eyeing Jaz Gulati and who he was. So I always like to do my research just to get the background because I don’t think we’ve ever met. So I’m really pleased I used to be on. Thank you very much for inviting me. 

[Jaz]
Well, I’ve been on the receiving end, some of your lectures, and I want to start by saying that as a public speaker, honestly, up there with one of the most charismatic, energetic and human, like really the way you speak, when I’m listening to you speak, Colin, it’s like no one else in the room.

You are speaking to me honestly, like you have this gift. I dunno if anyone’s told you this. If not, then you need to hear it then, the way you came my radar is dentinal tubules. Maybe in 2019 or something you might done a talk about leadership. Do you remember? 

[Colin]
Yeah. Maybe. 

[Jaz]
That and a few other lectures you done on, on digital dentistry, implants kind of stuff. So honestly, the pleasure is all mine to have you on the podcast and I know of all the wonderful things you get up to, but for those who are listening around the world, many in the UK, some in Australia, many in the US. Tell us about yourself, Colin. 

[Colin]
Geez, that’s a terrible question. So my name is Colin and I’m a dentist. I’m Scottish and I’m very proud of that. I live in England, so I’m doing, I’m trying to do the good work at, do missionary work in England of converting them to the way of the Scottish guy. And I’ve been doing that, I’ve been here for nearly 30 years. And so I live in Nottingham in England, home of Robin Hood.

I am married to Allison and we’ve been together nearly 30 years. I have three children, Grace and Rosie, and Callum. I’m a big into family, love my family to bits, so obviously, and that’s a big part of my life. I am very proud to be a dentist. I’m like first generation university student in my family.

So no one had ever been at uni before. So my mom and dad, did amazing things to get me to university, which I’m so grateful for. And then I’ve had this absolutely just grandstand, extraordinary journey of madness through dentistry for the past 31 years. And I honestly, like, I feel like someone will tap me on the shoulder any minute and tell me there’s been a mistake and I’ll have to stop.

And that’ll be fine because I’ve had such a great time. But if they don’t and I stay well, I’m 53. I have another 32 years left to work, so I’m working till I’m 85. So that’s the story. I mean, if there’s more detail, I’m an oral surgeon, by trade, but I don’t believe in specialized dentistry anymore, which is an interesting, probably separate podcast, I believe in general dentistry and good general dentists.

And that’s what we do a lot of here. But I’m big in the implant world in terms of that’s my world. And I get to do some super ridiculous cool things because of that and travel to places and meet lots of amazing people. And that’s been a joy. So I have a very brilliant portfolio life doing crazy things, and I don’t really know how I got here because none of my plans ever came true. So, that’s, I hope that works as a brief introduction Jaz. 

[Jaz]
Absolutely. I knew that your area of interest and what you are known for, you’re known for many things, but like implants is your thing. I didn’t, I must have forgotten that you were actually, on the specialist register, they oral surgeons.

So I forgot about that. So great to have you on about that. So, like you said, though, general dentistry and the fact that good general dentistry is what matters rather than specialism. So I like that little snippet. Could you expand on that? 

[Colin]
Yeah. Well, I think in the UK we ran down the route of specialization a lot, right? And we sort of lauded the specialist and we never did it properly. I don’t, in my opinion, so we never created the specializations properly and we never really let the public know what the difference was or even just categorize it well enough. And so look, I got on the specialist list by default in 1999.

When it first opened, in surgical dentistry, and then it was moved to oral surgery because they closed that, because they hadn’t done it properly. But the problem is that like a lot of specialists are not very good dentists, in my view. And a lot of journalists are the most extraordinary dentists and the guys that I work with around the world now.

And I get the privilege of working with, because I run education for a hundred countries for a foundation, I get the privilege to work with the best dentist in the world. And I do, and I get to meet them and see their work. And most of them don’t consider themselves specialists. I mean, they might have a ticket in here or there, but they don’t, the best example is Ronald Young, who’s become one of my great friends, and he’s probably the most famous, certainly the most famous implant surgeon in the world.

And his University of Zurich, he’s a professor there same age as me, but I’ve watched him in clinic. He will cut a veneer prep, he will do a consultation for a patient. He will scale teeth if it’s necessary. He will do an extraordinary implant placement. He’ll restore it. He will be careful with the occlusion, and look at this, he’ll look at the patient holistically.

That’s a dentist to me. That’s what a dentist is. So if you can’t, if you’re not a physician first and you’re not concerned about a patient’s health first, you’re not a dentist, in my view. So, and I think we lost that, and I think people chased a ticket because they thought it would generate them income. And that’s not true. And it shouldn’t be true either. 

[Jaz]
I see that and I see incredible value in being a good generalist and having array of skills, not just honed into one specific facet. However, some of the advice that we’ve spoken a lot about on the podcast previously is finding your niche.

One thing I talk about is a niche kebab, right? For every one thing that you add on, you remove something else so that you refine to like two or three things that you love doing. Where does that fit into what you’ve just said just now? 

[Colin]
So one of the joys of my life previously before I became injured, was the triathlon. I would compete in triathlon and so I would swim and bike and run. And I was never really that good a swimmer, but I could swim. I could swim okay. So you can’t be a triathlete without being able to do all three. If you can’t swim, you can’t race. Now, you might get really, really good at running, and if you get really good at running, it doesn’t mean you’ve stopped to being able to swim.

So if you learn how to take a tooth out, it doesn’t mean you forget how to take a tooth out. So my best example for you, I guess there’s two, if I could give you them, right? The first one is if I’m an endodontist, I’m a specialist, endodontist, and I open a tooth, right? And I look at it and it’s cracked, mesial, distal, then you can take it out.

The endodontist goes, well, I don’t take teeth out. And the patient’s going, well, I’m here. I’ve traveled for an hour. 

[Jaz]
Numb.

[Colin] I’m numb. I’ve paid for it. And they’re going, oh, that’s complete nonsense. Okay. And the other one that’s nonsense, I’m afraid is orthodontists who can’t take x-rays. So that is one of my greatest bugbears, right? I think we’re through that potentially, but I’ve had people like that that worked with me and they go, I don’t take bite wings. And what do you mean you don’t take bite wings? Right? You can’t? Have you? You don’t have, have you not got any hands? Why do you not take bite wings?

And so I’ve seen some turnarounds, I’ve seen get-outs and bail-outs in dentistry based on the, I’m a specialist, right? And I’m sorry that, I can see whether if the tooth to be extracted is super complex and they go, it’s much better if somebody better takes it out. I get that. But not if it’s a central incisor.

Right. And I can see that there are circumstances where the, where it’s better if someone who’s more experienced or more skilled in that area does it, totally get that. But there’s so many ways where the specialists go, I don’t do that. I don’t do that. And we need to just move away from that because we should all do our basic training.

We should all learn how to cut, cut, access the tooth. We should all learn how to take a majority of teeth out, and then we can enhance our skills from there. And then of course we can become a GDP ortho, or a GDP implant, or a GDP Perio or a GDP. And they’re the really good guys.

They’re the really good guys. ‘Cause they can do a lot of it and they can build relationships with patients. 

[Jaz]
Amazing. Well, I love that ’cause I agree with it so much. And there might be some facets which we disagree. And let’s see how this podcast goes. Let’s find, I love those moments.

Colin, actually, so let’s try it. Okay. But there’s so much to learn from you, Colin, because what I wanna grasp from you today, the first theme is consent. And specifically, what you do is complicated in the sense that, it’s more specialized and complicated, sinus lifts or all our next potential.

So things that are worth a lot of money. Things that a lot of take time to things that take a lot of surgical skill and training to be able to do. What I have seen from colleagues who are, similar, high level as you, is that the consent, the way I’ve seen consent being done, what my principles used to do that I work with in the past, and what I’ve seen from mentors is that sometimes consent is like this 30 page booklet almost, and it’s incredibly exhaustive.

So I just wanna know, right? ‘Cause everyone’s got their own unique take on this. How do you see, what do you think it takes to be able to adequately consent someone to something that is a bit more refined or something that’s a bit more niche treatment. That’s quite a big deal, right? For these patients to receive surgically, like for example, let’s take an example of a wisdom tooth that’s impacted.

You can do that in a one or two page consent form. The fact now that the treatment you’re doing is worth several times more than that, or several more nuances, how does that change how thick that pad of consent becomes? How long does it take to consent someone? What is the procedures that you do to make sure that you can look someone in the eye and say, you know what? I think I’ve adequately consented you. It’s a big question. It’s gonna take lots of pieces, but, I’d love to take your thoughts on that. 

[Colin]
That’s brilliant. Every question that you asked Jaz, is another podcast. It’s beautiful, right? But I will try my best to be as brief as I can, which is not one of my greatest talents, I’m afraid.

But, first of all, you can talk about this in terms of the UK or you can talk about it in a broader scale, right? So the UK is quite a unique environment for consent in the world. And, I know that you have a big listener group that should outside of the UK that’s so I believe so, so perplexity tells me anyway.

And so let’s do it genetically consent, right? If we can do that. And so certainly from a UK perspective, but genetically for the world consent is a relationship management exercise. That’s what it’s a hundred percent. And so in the United Kingdom, and not to go into too much detail, our consent was massively altered by, legally by a lady called Nadine Montgomery, who was an extraordinary woman.

And I had the privilege of having dinner with Nadine Montgomery and to watch her speak and to learn all about her story and all about her son Sam. And they changed consent in medicine in the UK. But when you speak to this lady who was vilified by the profession, because she was the one that gave us, made us much harder, it was much more difficult for us to consent patients.

This was gonna kill medicine. It’s not at all what she wanted. She wanted us to understand her. That’s it . so your job is to understand your patient. That’s it. Now you can put down- 

[Jaz]
Can you just explained, for those who don’t know about Montgomery, just to give us a little context background. 

[Colin]
I very Montgomery, was she- In the United Kingdom basically, we used to the test used to be, if a reasonable other practitioner said, that’s the way you should go, then you didn’t get sued.

But what happened to Sam Montgomery, Nadine’s son. When Nadine was pregnant and she was a diabetic and she had pre-eclampsia, so she had high blood pressure and she asked for a section and she was denied a section by a female gynecologist. Because at that stage she didn’t like doing sections and Sam had an anoxic injury at both of was born cerebral palsy.

And when they went back to it, she said, you didn’t listen to my concerns about this and had you to them. He might not, I might have had a section and that might not have happened, but she had to, she trained to be a solicitor to change the law. It took her 15 years right now. So what she said was, listen to me when I’m speaking to you please, because I need to tell you my concerns and what Montgomery-

The philosophical part of Montgomery Consent basically says, know your patient in order to treat your patient. So you can’t treat your patient as if they were you. You have to treat them as if they are them. So anybody who practices the way you practice Jaz, totally gets that. So Montgomery consent is no threat to you.

And the other side of this is that in countries where litigation is high, so for example, United States, UK, Israel, right? Those are three biggest ones. We’re terrified of being sued. So we defensively practice really heavily. That’s not the case everywhere at all. It’s not the case everywhere in Europe.

So you would go to Spain and assume that people would consent like they do in Britain, and they don’t because they don’t need to, because the law protects them in a different way. And even in the United Kingdom, the law protects the dentist or the physician much better in Scotland than it does in England, than it does in Ireland.

So that’s mental. So what you want me to give you is, I think I have it here. One second. I usually have it on. Oh, I usually have it on my notice board, but it’s gone somewhere else. I have a blank laminate, a piece of blank paper laminated, and I say, if you want to avoid getting sued, here’s your instructions, because there isn’t an instruction you can’t avoid.

This is human interaction. You cannot systematize it, right? All you can do is do your best to understand your patient. And unfortunately, for a lot of practices of the United Kingdom, who still work either in the NHS or independent practice, who an enhanced version of the NHS, they’re time poor.

Same for GPs. So you don’t have the time to spend a minute to get to know the person who you’re actually treating. And if you spend them, if you take a minute, then you can send patients. And of course we back that up with we, what we do now is we do everything based online. We have online booklets, which explains every procedure.

We do a bespoke letter to the patient and we say, read your booklets and ask any question about the booklet that you want. But when you sign at the bottom, we’ve assumed you’ve read the booklet and you’ve answered all, I’ve answered all your questions, and we give them the headline potential complications.

And that’s all we do. But we’ve done that in an environment where the patient trust us and we always, if we’ve done a say, an immediate, for large case for a patient, we’ll go to a patient, this is really complicated. There’s lots that can go wrong. So we don’t sell it on a false premise.

And I think people get into a lot of trouble because they’re desperate for the work, so they downplay the good and the bad side. Taking all of someone’s teeth out and replacing ’em with implants is a huge, huge procedure. And it’s not to the same on the other side. 

[Jaz]
Colin, just want to add in, because I’m enjoying this, but I just wanted to add in one thing, very pertinent to what you just said there, is sometimes colleagues will say that I’m afraid of going to, making the conversation too negative a warning of all the risks. ‘Cause then I’ll lose the quote, unquote, I’ll lose the sale, I’ll lose the treatment acceptance, but I’ll lose the, that’s our point of consent.

[Colin]
But it’s also because you need so much emotional intelligence to be a healthcare practitioner. Clearly, that’s the thing. You can talk people out of any treatment you want. It’s dead easy to talk ’em out of treatment. Because you just say that, well, this could go catastrophically wrong. But it’s a pragmatism test with the patient.

You’re gauging their level of pragmatism. If you’re unable to accept a certain degree of risk, do not have this treatment. And I, this year I became a surgical patient. I had a quite a big surgical procedure carried out at 10, 9, 10 weeks ago. And I went catapulted into the world of going and in medicine, in private medicine.

I mean, they never consented me in writing hardly at all. It was ludicrous. Right. And I was totally cool with that because we had a chat about it and he said, look, there’s not a lot to go wrong with you, but it could, and in fact, something did go wrong. Right. But that’s the deal. Okay. And if you can get to that with the patient, I think there’s a word for it that we used to use in healthcare ages ago.

Trust. That was the word, that’s what it was called. And so you’re trying to develop a trust relationship, right? But if you are a crook, it’s your trust is false. If you’re not, there’s nothing to worry about. 

[Jaz]
It’s bit of being your authentic self and allowing the human side, like emotional intelligence is the best way to do it. Having respect for the patient enough to give them an opportunity to back outta something that perhaps is not for them. And the only way you’ll know that is discovery of who the patient is in front of you. 

[Colin]
A hundred percent right. And there’s also just a final little of say to this, ’cause my daughter, who’s not a dentist, and none of my kids are in healthcare ’cause I’m a terrible example.

Well my middle daughter is a physiotherapist, so I guess that counts as healthcare. But, my eldest officer is a biochemist, but when she was at, finally in school, she did a project at Cambridge University. She never went to Cambridge, but she did a project when she was at school. And it was a, it was psychology.

It was assessing the degree of risk that practitioners applied to their patients or to their family as patients. Get it? So let’s say you’ve got two, however old your wife is. Let’s say she’s 25, Jaz, right? So your wife is 25 and you have a another 25-year-old patient. They both need a wisdom tooth out.

You’re liable to push the one you don’t know away and take the risk on the one you do, which is mental because you believe in the treatment and you understand the risk benefit analysis, and you think you won’t get sued. And that’s an awful world to be in, right? So we actually will be happy to take greater risks on people that we love because we know the benefits are worth the risk than we are on patients that we’re concerned about because we didn’t get to know them in the first place.

[Jaz]
Well, that’s the epitome of defensive dentistry, isn’t it? Right there. The fact that you not willing to help someone who may benefit from that treatment overall, but because we’re afraid we’d rather push it to someone else or not offer it. And that really is defensive dentistry right there.

[Colin]
And of course, the ultimate sales tool, if you want a sales tool, is to explain two procedures to the patients and say, so let’s say you and my, how old, could I, Jaz? How old are you? 

[Jaz]
I’m 35. 

[Colin]
Okay, so you are genuinely young enough to be my son. So I’m gonna say, here’s the two options, Jaz. If you were my son, Callum, I promise you that’s the one I would do.

And if you have developed a trust, nine times outta 10, the patient goes, that’s the one I would like. If you’re true, if that’s true, I’ll take it. But it comes to- 

[Jaz]
So that’s what you would say to your pa, I mean, this is something that you, this is how you communicate to a patient? 

[Colin]
Yeah. 

[Jaz]
I think I resonate with that and I I think that’s, ’cause patients often ask, what would you do? And so let’s tackle that, right? Because I’m sure you get that all the time. When a patient asks you, what would you do? How do you then make sure that you’re not giving them the answer? Because it’s not important what you would do, Colin. It’s important that you’ve understood them well enough to relay back to them that actually, based on what you’ve said so far and based on what’s important to you, this is what I would do based on you, not on me.

But how do you have that discussion more elegantly? 

[Colin]
Yeah. So I would spin that back to the patient and say, I don’t think that’s the question. I think the question is, what would I do if you are my wife, brother, mother, daughter, son? And so I’d say what you want me to do is use the experience that I have to pigeonhole you as a member of my family and then to treat you accordingly.

[Jaz]
I love that. That’s great. That’s wonderful. I’m gonna keep that as a teaser at the beginning of the episode. That’s awesome. 

[Colin]
Yeah. Alright. Okay, cool. Wonderful. 

[Jaz]
So, with the consent, going back to it, so you said you have the pre online stuff that they do. So they already have some prior information they’ve kind of pre-qualify themselves.

And then you have some discussion in the clinic where you get to know them and you decide, okay, is this dance for both of you or not? And then of course there’s the squiggle at the end, which people say it’s not worth the ink is printed on, et cetera. How are your consent forms like massive?

And your treat plan letters, because, ’cause quite often I’ve heard is the treat plan letter is not really for the patient. Yes, it’s addressed to the patient, but that treat plan letter is for the lawyers. 

[Colin]
Yeah. Let me take you back a step to the process if I can do that.

[Jaz]
Yeah, please love that. 

[Colin]
Let you pick an implant. See a patient who is referred to me or refers the themselves to me for an implant consultation. First of all, it’s one hour, right? And people will say, well, it’s all right for you. Well, it’s not all right for me that it’s an hour. And that is what you would call in business a loss leader.

I do not get in that hour enough money to pay that surgery running. Okay? So let’s be clear about that. But we still charge for that. And we charge what seems like a big number for that, but it doesn’t cover our costs. And one of my big areas of interest is the business of dentist. Right? And so, we see the patient for an hour, and I came on here and I’m not interested in punting anything that we do, Jaz. I just wanted to have a chat with you. But we do teach this formulaically, okay? 

[Jaz]
Yep. 

[Colin]
And there’s ways of doing this, and we divided the hour into four 15 minutes. So if you choose to do it as a 20 minute consultation, you can divide it into fives, but fives are not long enough. Right? But that’s fine. I get it.

I get you might have to do that. Right? So the first 15 minutes is called building the bridge to trust. So the patient gets pre-qualified by a TCO, who are brilliantly trained to say, what do you need? What do you want? And we have 56 of us here. So they get put in the right place depending upon what it seems like they need.

So there’s lots of people doing implant here. So often people will be, well, I call and treated my husband 10 years ago, or whatever it is, right? So they come and see me and they sit down and I go, it’s really nice to meet you. And the first 15 minutes is nothing to do with dentistry or anything.

[Jaz]
And the first 15 minutes is with the TCO or is with you? Sorry. 

[Colin]
No, no, no, no. 

[Jaz]
Does the TCO happens beforehand? 

[Colin]
But the TCOs talked to ’em on the phone, booked to appointments. 

[Jaz]
Okay. 

[Colin]
Got that information. That information is all set up for me before I see the patient. Any concerns the patient has, what they might be interested in, what the history is, that’s all done, right?

So you are using the team, enhancing the team all the time, and then the patient comes in and then you say, let me tell you about this. And I go, no, no, no, no. I need to know about you for the reasons that we’ve just discussed. Only once I’ve ever had kickbacks from that where I gotta go.

Why are you asking all these questions? And I’ll say to ’em, because I can’t decide what I think you might want unless I know who you are as a person. And so that we call that building the bridge to trust. And the purpose of that is A, to find out about the patient and B, to open the door to share personal information.

Psychologically, if you allow me to share information about me, you will share information about you and we will trust each other. It’s basic human interaction. I will make myself vulnerable to show you that you can trust me. It’s really clear how we do that. The second 15 is the mechanics. We do that really quick.

[Jaz]
Can we break this down? ‘Cause obviously we can go in any way we want in this podcast, but this 15 minutes, like a lot of colleagues will be uncomfortable with this because they may be coming from a background where their entire consultation is 15 minutes. And now to spend 15 minutes to, to learn about someone, it seems like an awful long amount of time.

‘Cause I’ve experienced this before with colleagues who have moved from one type of practice and to another practice where we had to do much longer consultations. And you notice that patients are coming in, they’re booked in for an hour, but they’re leaving after 20 minutes because the clinician is just so used to doing everything so quickly.

What kind of like in the whole interviewing sequence, like how do you encourage the patient to warm up and loosen up and talk about and what exactly do you wanna know? Do you wanna know about their cats and dogs names and what they do on the weekends? And like to what degree are you learning about them?

[Colin]
So I totally get that right. And it’s important that when you enter this world of practice, which is a different level of practice to that, which a lot of people are working at, and to quote the film Rocket Man, and I use this quote a lot of the time, you have to kill the person you were born to be, to become the person you wanna be.

Okay? And that’s difficult. So you don’t get, this is not easy, nor is it supposed to be easy, right? You can learn it and you can practice it. And it’s been well proven that emotional intelligence is a developable skill. It’s a practicable skill. IQ is not, but EQ is, right? So what we’re looking for is a series of opening gambits, right?

Conversational opening gambit to seek out a common ground with the patient. So if I was saying to you, do you have any children? What would you say to him? 

[Jaz]
I’ve got two boys, two young boys, six and two. 

[Colin]
How old are the boys? Six and two. Yeah, you said six and two. Yeah. What are they like, what is your 6-year-old like? What is he like? 

[Jaz]
Well, his sixth birthday is coming up. We’re doing a Marvel theme birthday party. He’s absolutely in love with Marvel. He plays cricket on Fridays and yes, it’s a great season of life to be a dad.

[Colin]
So I have a 17-year-old boy called Callum. So he used to be six. And during the ages of, between about six and 14, we were able to go do the whole of the Marvel Universe as it came out. 

[Jaz]
Nice. 

[Colin]
Up into, we saw a end game when it was just released. And so I can promise you that if you share that with your son now, the benefits you get when he’s 17 are extraordinary. Do you see what I just did? 

[Jaz]
Yes, absolutely. Yeah. You gave something a personal information about yourself. 

[Colin]
It took me one question to do that. Sometimes it takes more than one question, are you married? Do you have children? What do you do for work? Did you travel far when you got here? What was your last holiday?

Do you read? Do you like books? Do you like movies? Whatever it is you want to share. And you’ll get to the point where, and the six degrees of separation, ancient research from the United States, if we got into this podcast for long enough, we would be able to find our six degree of separation. You’d be able to say, well, actually, my uncle lived in this part of Scotland for a little while and then he moved to here and I’d do, oh my God, my mom and dad lived there.

And we would go, bang. And you almost always reach that moment in that 15 minutes where you go, bang, that’s us. To see how we are connected, shall we continue with dentistry? And it’s not difficult. It just takes a bit of explanation to do and a little bit of practice. Imagine that was your work. Imagine part of your work was to do that. What a beautiful job that is. 

[Jaz]
Well said, well said. To build that bridge is a truly wonderful thing. Now, I’ve seen some of your social media stuff and also in your lectures you talk about books and stuff. If someone, if a young dentist like is wanting to quite rightly develop their EQ, which is one of the most important things they could set themselves up for their career. Are there any resources, books, courses, anything that you could recommend to help develop their EQ? 

[Colin]
Well, first of all, they won’t read a book because they’re younger than me. And so if I recommend them or buy them a book, they never read it. So what they’ll want is an AI summary in about 250. So what I would suggest, the young person, let me bracket this in ages.

If you’re under 25, go at GPT or Claude, whatever you like. And ask for a 250 word summary of emotional intelligence by Daniel Goldman and ask for another 250 word summary of talking to strangers by Malcolm Gladwell. Once you’ve taken the effort of reading that 500 words, you won’t be qualified, but you can use that as a platform for moving forward. If you’re older, if you’re between 25 and 40, listen to them on audiobook. And if you’re over 40, read them on a Sunday afternoon in your conservatory. 

[Jaz]
I love that. Okay. So yeah, at least you have two book recommendations and different media in which to consume in, depending on what phase of what seasonal life you’re in. The first 15 minutes, what are the second, third, and fourth, 15 minute segments of that implant consultation.

[Colin]
Second is the mechanics. So that is the absolutely standardized formulaic examination for a patient, which is, and I’m not, I promise I wouldn’t swear on this podcast. I promise I won’t. I nearly did. It’s absolutely cast iron, right? So if someone comes to get you, you’ve filled in all the stuff you were supposed to fill in — the complaint, your history of present complaint, your past medical history, your occlusal analysis, all of this stuff is done right. So just do that- 

[Jaz]
Data gathering. 

[Colin]
With an extraordinary nurse who does your notes and take your photographs and check if you need any radiographs. I don’t take a lot of radiographs nowadays at consultations, but that’s probably pattern recognition from experience. I’m cool if you take radiographs, if you want them.

And sometimes I do, but usually I can formulate a plan provisionally for a patient and usually CBCT, everybody because it’s implant work. But actually I’ll do that if you accept a plan, but I’m not frying you if you don’t. And so that’s it. That’s that bit. And then the third part of it is the bit where you go, okay, let’s pull together what the possibilities are for you here.

And so that is pulling the possibilities together, showing the patient what sort of options they might have for treatment and having that discussion initially. And that runs into the fourth part, which is then the after part of the consultation. So how do you follow that up? Who follows up and what do they get?

And how do you consent a patient afterwards? So that you know what to tell you what happens in our place, and I can show anybody how to set this up, and it’s extraordinary is that TCO deals with a patient and we’ve got five TCOs here. They’re fantastic, but they’re so dialed into our philosophy of how to work, right?

And our philosophy of sales are kinda hate sales, but we have to sell things. So they bring the patient in all the information. So generally speaking, they come in, we do the consultation. Generally they pick that person who’s already spoken to the patient, picks ’em up again, other side, right? Not on the day.

I say to ’em, we’ll be in touch within a day or two. Now we also have an MDT here, which is a multidisciplinary team group, which discuss cases every Tuesday. A lot of the patients go to that, they love that. But it’s a huge thing now, different podcast, but if it’s straight, if it’s relatively straightforward, I dictate the plan.

I fill the plan on my (PMS) which is Dentally, we use. And those plans are presented really well. They’re standardized in the presentation. Fantastic. I dictate a bespoke letter to the patient on Slack. That letter is then formulated and it’s put in a lovely package digitally with the treatment plans, and it goes out of dentally to the patient.

Now it goes, we can tell when the patient opened it obviously ’cause dentally, you can tell from which what IP address it was opened on at what time. So if they ever tell us they haven’t read it, we’ll go, well, will you open it a few? There’s a few things happen. Then patient opens it and signs it. That happens.

They haven’t even been back for a second consultation. The next thing that happens is the TCO phones them and says, are you happy with it? They say, I’ve got some questions. The TCO answers the questions, they sign it, and they all come for diagnostics with the nurse, not with me. So then the nurse does a diagnostic appointment for these guys into treatment.

The next thing that happens is they have, if they don’t want to do it, they want more questions. They have a teleconference with me, right? They have a Zoom call recorded, and the final thing is they come back to talk to me again. But that used to be the standard format. First consultation, second consultation.

I second consult. Now maybe 10% of cases. ‘Cause they go ahead with treatment because of the process. Or they have a zoom call at the end of treatment and the Zoom calls are much quicker than they’re recorded. And they’re much better. And I can show them all the photos and their x-rays on a Zoom call. So the process we have now is really good, but it’s based around the fact that they trusted it.

And I can show you, we invented the treatment box. I don’t know if you’ve ever seen it. I haven’t got one here. And analog days, we did this with Chris Barrow and he took it around the country. We had this beautiful, it was like an iPad case. When it fell out, it had an SD card in it with Campbell clinic, SD card.

It had a teabag, it had all our documents printed under here, but it had them all electronic here. And we put it through the post and that’s what arrived. We’ve done that digitally. Now we still do have that, but we do it more digitally now. So that part of the, how you present the plan, that’s kind of like a given, right?

That’s like checking the patient’s occlusion after you do a composite. That’s gotta be right. And it has to be good depending upon what level of the market you’re at. But the key, the secret sauce, is at the start of the process. 

[Jaz]
Okay. So it’s all the data gathering that you’ve done beforehand. It’s the TCO involvement. And it reminds me of, sorry, you were gonna say. 

[Colin]
The trust. It’s the trust. It’s building the trust. 

[Jaz]
That first 15 minutes is absolutely golden. Without that, you can’t get to where you do eventually end up. And so go back to a little detail though. Like, imagine you’re doing this immediate, full-arch implant treatment and going back to what I said about making those treatment plan letters, like they as though they’re for the lawyers, right?

Not so much for the patient, but the patient is the recipient. To what degree do you subscribe to that and to what degree in the digital sort of sending of these, Adobe sign or whatever you might use, would you say that compared to your co colleagues or people practicing a civil level as you, can you describe what your plans may be like compared to some other industry examples?

[Colin]
So I was an expert witness at quite a high level for 10 years. I am expert in criminal cases beyond civil cases as well. So I can tell you that the law is an ass, and effectively everything becomes a negotiation. So whatever you do to protect yourself, it’s not enough. So stop stressing about getting to a hundred percent and don’t.

Now the way we do it is we have, in your consent letter, we have all these links. So we’ll say dental implant information, full arch reconstruction information, endodontic information, and we put those in if it’s appropriate for that treatment plan. And our admin support does that. So we say in the letter, make sure you read all that stuff.

I’ve told you about it, but make sure you read it. It’s credit card, there’s credit card, Ts and Cs. When did you last read your credit card? T and Cs. And so, never ever. And did you ever say, well, I’m not having the credit card, because actually it remains their property at all times. Never. But you do get patients who want it.

This is the spectrum. So, what we also do when we talk about consultations is, and we’re getting a bit deeper here, is there’s, we’ve got five types of personalities for consultations, right? Five types of personalities, right? So take my personality type, right? I’m a CEO personality. I’m not a CEO, but what I do is, so I can tell you that within about, we’ve never spoken before today.

I’d never met you. Within about 30 seconds. You guys, I really like you and I trust you because that’s what the CEO personality does. But that’s what the CEO personality does, right? And so, if you stitch me up, the wrath will be terrible. So when you get the CEO personality, when I go for my, it was a knee operation I had, when I meet the surgeon in the waiting room, I had bought him, done. And he’s going to me, we’ll send you an estimate and I’m going, blah, blah.

But it’s you. So the CEO personality, they trust really quickly, and so they’re never reading a word of what you sent. Never. They won’t sign it. 

[Jaz]
It reminds you of the book have you read, Surrounded By Idiots? 

[Colin]
Yes, yes. 

[Jaz]
So you are very much the red, dominant? 

[Colin]
A hundred percent. But the other personality types are the engineer. So the engineer goes, if you can’t get the engineer, I just wanna show you a prop, right? If you can’t get the engineer and tell him this is a fantastically clever printed crown that I’m not telling you about a podcast, but if you can’t tell him exactly what that’s made of and why you’ve lost.

So the accountant personality, they don’t have to have these jobs. The detail about the detail and about the money and all of this stuff, and they have to be really clear. The teacher, they want to tell you. And then the worst one for ethical drag is the passive. That’s the 40, the 50, 60-year-old lady who’s lost her husband, who trusts you, who’s got plenty of money, and you go, oh, do you know what?

I’m gonna spend your money? So you have to be really clear in your ethics for treating that patient. So that forms part of that process of building the bridge to trust, because those guys need a different calling. Each of them needs a different calling. And that’s emotional intelligence, right? And you can build on that and you do that.

But we give you a framework because it seems complicated now and you have to practice it, and that’s serving patients for what they need. It’s not gaming the system. There’s nothing bent about it. It’s saying, as a professional, I’m prepared to be the person you need me to be, to look after you.

[Jaz]
And what I like about that is, in your communication, in your letters, you are making sure that all bases are covered so that they can go as deep as they want. For example, if someone wants to read the T’s and C’s for credit card is there, but a bit like me and you, I’m very similar to that. Like, I’m very quick to make decisions.

I’m very slow to change them. And so I go by trust. My currency is trust. Maybe my principals who listen to the podcast as well, maybe they don’t wanna hear this, maybe they do wanna hear it. I don’t read the contract, but when I sign, I know lots of people get very deep into the associate contract.

It’s not my personality type. I go by trust. I look John and Chris in the eye. I was like, do I trust these two? Well, John I went to dental school with is one of my best friends. I was like, yeah, I trust these guys and we buried the contract and the day need to pick it up is the day that we need to rip it up and and move on.

[Colin]
A hundred percent. I don’t look at it again. 

[Jaz]
Right, right. So that’s how I operate. But I appreciate that my patients are not reflection of me. They’re very different. And therefore the way I do it, Colin, is that I do a lot of Loom videos. 

[Colin]
Yeah, yeah. Loom video, we use a lot. 

[Jaz]
Exactly. But I know that for a lot of dentists, they struggle. They messaged me saying, Jaz, you talk about Loom, but my first one took me an hour to do. And so, whereas I can bash ’em out in five minutes, everyone again, it’s a exercise that you’ve gotta practice and practice and refine.

[Colin]
You have to systematize your process, whatever your process is. The phrase over the overriding phrase for our consent process is a sheep and wolf’s clothing. That’s what we are. So we are prepared to put on wolf’s clothing for our consent, but we are a sheep. So we are soft and kind, but as far as the consent is concerned, if you go into my consent, it’s as good as anybody’s, but it just doesn’t look like a 45 page massive document that that terrifies you.

That’s the thing that terrifies you. And so I’ll say to the patients, these are the risks that you could get from this. But, I worked in head and neck cancer, so I see how people are consented. My wife works in children’s cancer, still people are consented for cancer operations on half a sheet of paper.

We had a little bit vain and obsessed about ourselves, you know, a little bit. We’re not really that important Jaz, not really. And we should always not be too, we shouldn’t take ourselves too seriously. 

[Jaz]
Excellent. Well, I’m gonna move on to the next. I thoroughly enjoyed that. The next bit I wanna discuss is elective treatments and a common scenario, which we all face in our career at some stage probably early on, is like the patient who comes in. And just to make it relatable to most dentists who are, listen to this, so I don’t wanna talk about like full large implant stuff that you do. But let’s say a patient comes in and says, look, I’d like to have a gold crown on my front tooth.

Okay. So that old scenario, which we’ve all faced before, maybe not, or we know a colleague who’s discussed it in the pub with you or on a Facebook group, more modeling. Where do you draw the line for yourself? Like, ’cause you might think that, hmm, is this really appropriate, but is this criminal?

Like, can I do it, can I not? What decision making criteria and what kind of consent skills do we need to be able to consent someone for this kind of electric treatment? Which you don’t think that you would want in your mouth and you don’t believe in, but it may not be like too farfetched.

[Colin]
A lot of dentistry is philosophy and the law is applied philosophy. If you’re not, we don’t teach our children philosophy, which is a huge shame because it helps us to navigate this stuff and who we are and what we think. And so the analogies to this stuff that I’ve always used, so we have a principle in the practice that we use when we teach a lot.

And if you saw me speak, you probably saw a slide that said prefix on it. Right? And it’s a linear analog scale. And as profit one end in ethics or the other, if we don’t make a profit, we die. We can’t treat anyone. But if we do that too much, we should be killed. Okay? And so we can’t be all ethics and no profit, but we can’t be all profit and no ethics.

So we as a team talk about this a lot. Where do we strike? And that’s a philosophical decisions. Interestingly, and I’ll always like to reference this kind of thing, I’ve not been on social media for 10 years, right? Came off in 2015 and my last Instagram post was a picture of my breakfast in 2015.

As a practice, as a business, we have a lot of that going on, but I don’t really see it. ‘Cause it wasn’t very good for me to be honest. And I knew that from early on. People do bring things to me and say, look at this. Have you seen this? And there’s a guy who was batting around recently who was comparing composite buildups to the price, we’re having a nails done.

And he was just going like, if you have your nails done, you might as well have composite buildups. So to me, and let’s be clear about that, that’s abhorrent having composite buildups. And I’ve had composite buildups for wear recently, and my wife never noticed high, still hasn’t noticed. I’ve had ’em done, but my teeth were 50% worn down.

So I had them for functional reasons and I’m delighted I had them. But to do it on a 22-year-old, we have to be really careful of that because that is not without significant long-term risk. Get it? To restore those teeth, to put on a plaque trap to in any way mechanically prep those teeth in any way is a huge problem.

And so we have to be really clear with the patients and tell ’em that, but we don’t. We sell it as a fashion aid. It’s not like buying a top or a pair of shoes, and it shouldn’t nails like that. It’s not well, nails and nails. It’s not like nails. Right? ’cause your nails will grow back and so clearly we have a responsibility to position ourselves where we think the ethics sit for us.

I always go back to do no harm. Part of my graduation, I was required to recite the Hippocratic Oath. Love it. Right? So first do no harm. I, as a practitioner, I will not harm you more than I help you. And so I still subscribe to that and I a hundred percent subscribe to fact to dentistry as a subspecialty of medicine.

I a hundred percent subscribe to that. And that changes how you look after people. Composite buildups for aesthetic reasons. That’s not medicine. And so that’s hairdressing. Let’s be clear about that. That’s it. There’s no health benefit to that. Don’t tell me there’s a psychological benefit, there’s no health benefit to that. And so I won’t- 

[Jaz]
The first thing that comes to my mind, as, I mean, I agree, but there, there’ll be lots of listeners who are listening to this right now saying, no, no, no. They disagree. It’s a skill. It’s artistry. It’s giving confidence. It helps their mental health of the patient. And they’ll be thinking that.

But then I would say that one of the things that was taught to me, I did a diploma in Ortho, and actually, I like the thing that the educator was saying was actually there are very few cases of ortho, which actually are functional and health ortho, the primary benefit orthodontics is aesthetics.

[Colin]
Yep. It absolutely is. Don’t get me started on ortho. I absolutely believe that. But I’m absolutely cool with straightening healthy teeth because I know that the long-term prognosis of those teeth is rarely. Not entirely, but really affected. I see plenty of resorption from ortho cases that we have to treat, right?

So again, that’s not without its risks, which should be explained, but covering teeth in polymer right, is, that’s a totally different game. You’re doing that, not you’re doing it quick. You’re doing it to create an appearance, which is unnatural, fashionable. And so I know that people will disagree with this, but do you know what we have to say it like it is, right?

And so I happily have that conversation with whoever you like. So the first treatment for someone like that is to straighten their teeth up. We don’t do aesthetic concept buildups where there’s minimal advantage to the patient. Not at all. We just don’t do it. We won’t do. I mean, just say the patient number.

[Jaz]
Colin? I know you don’t know anything about me in that regard in my clinical practice, but, I made this video, which again, got a lot of love, but also got a lot of hate because I said very much like what you’re saying now is like, I don’t like seeing teeth plastered with composite and I got a lot of pushback on social media from people who like doing so.

But I’m with you and all of men or most of my orthodontic cases that I do like, aligners and stuff. Once I’ve got the teeth in enamel whitened. Yes. And looking great. I don’t wanna touch ’em, I don’t wanna have to put composite on them. Whereas I know people are quick to do that and then to build more volume.

Give the wow effect. Give that shine with the composite. And I see lots of my colleagues do that. But, I’m not just saying this to agree with you, but I think just for those who are listening right now, that actually I think that’s a great point that, when you do that, it’s not as reversible as we’re saying.

So the kind of language that’s being spoken on social media, Colin, I know you said you’re not on social media that much now, but like people are saying no injections, no drilling, no this, we’ll put eight, 10 composite veneers in three hours kind of thing. And that I think has got lifetime implications that probably are not lifetime discussed or make clear lifetime implications.

[Colin]
Lifetime implications. And you’ve not been doing it for that long, so you don’t know if it hasn’t got lifetime implications. The problem is, it’s a relatively new thing, but it’s not new. Jaz, in its principle because in the nineties we were doing Larry, Larry Rosenthal, veneeriology, and veneeriology was to protect.

That’s all the same arguments were used there. And what we see now for the Larry Rosenthal veneeriology is terrible, right? So when we were using porcelain to do this, it was awful. And it’s not, I mean, we’re not prepping perhaps as much, but let’s be clear, you are sticking resin onto these teeth.

You’re creating plaque traps, you’re creating ledges. And please don’t pretend that everybody that’s doing this is an artist. They’re not an artist, right? At the very top, two or 3%, they are an artist. But the guys that are doing it quick, down the bottom end, it’s garbage. Right? And we are seeing it coming through the door and they’re not finished properly.

And they’re done cheap. It’s just, it’s really bad work, right? And it misrepresents the industry as a profession when it’s done badly like that. And I’m sorry, and I know people won’t like that, but you can’t please all the people all the time Jaz. And sometimes it’s important to say, so sometimes it’s important to say much. Would my kids have that? Absolutely, never would they have that. 

[Jaz]
Okay. No, and I’m glad we moved away from that gold crown scenario. ‘Cause actually what you are saying is far more relatable, which is the comp veneer wave that we are seeing. And this is a huge thing, like my social media, the algorithm is just constantly showing me this.

And yes, I get it with, it’s a peg lateral. Okay. Like, the two actually that has got some space and size issues and stuff and I get it. But when you’re seeing, so what I’m seeing is lots of eight or nine out of 10 smiles being converted to the short term, 10 through the use of resin or veneers and stuff.

And I think that’s where you’re saying that actually that’s the point. At which do we see the benefit and risk analysis a way up and what you are saying, the whole prefix thing that actually, that one probably maximizes on the profit and not so much on the ethics. So that was just a reflection, not so much a question.

[Colin]
So listen, it would be very easy for us Jaz, you and I to create an index for treatment for composite veneers and we would be able to look at the case aesthetically and say, is there a significant aesthetic detriment to this patient which could be causing a psychological upset objectively. And very few of those cases would qualify and you know that’s true.

And so if we set up that we should do that, and if we set up that objective index and anybody who did it apart from that with clear clinical photographs before the treatment went to jail, then lots less people would do it. And I know that the good, the benefit of not being on social media is, it’s very difficult for the trolls to get to me. So I think that’s why it’s possible for me to speak about that. They still will though. Someone will, in a roundabout way, still manage. 

[Jaz]
I’m sure they will. But look, I think it’s important to discuss these and whilst I do host guests who are veneeriologists and do wonderful, beautiful work. 

[Colin]
And you should.

[Jaz]
Yeah. You definitely should get all perspectives. Yeah, yeah, yeah. But I like your perspective. And I agree with it in the sense that I’m not so prolific in the whole composite veneering. I think there’s a beauty to enamel. And so that is a level of elective treatment that everyone needs to decide, okay, where do they, which side of the line they’re on.

And actually to have a, some sort of line somewhere. So what, before we move on to the final thing, which is about selling in dentistry, what’s the final piece of advice that you wanna give to a young dentist about elective treatments and staying safe and doing the right thing when it comes to elective?

Yeah. So the Gold Crown was an extreme example. I’m glad we moved away from it. But composite veneer is a wonderful, real world example. What advice do you wanna give in terms of elective treatments? 

[Colin]
Okay. I think that, and this could take just a minute or two, but. 

[Jaz]
Yeah. Yeah. 

[Colin]
I’ve been talking to new graduates since 1998 and you’d asked me earlier on about a lecture that I did for dentinal tubules or something.

I think I stopped counting lectures about 2000. Right. So I’ve done a lot of speaking, so I can’t quite remember everyone that I’ve done, but they, so I developed these approaches as we talked. 

[Jaz]
Can I remind you something that stuck from that lecture? I’ll remind you something, Colin. It was when you spoke about leadership and an example of leadership you gave is a patient comes in and they had like an amalgam tattoo or something, right?

[Colin]
And she was like, yeah, off the left. Left. I remember, yeah. 

[Jaz]
Is it, is this cancer? And you were like, well, actually everyone’s like bouncing around ’cause they’re afraid to say that it is not cancer. You’re like, it’s not cancer. Don’t worry. They having that leadership, that’s how, I remember that. 

[Colin]
That was a clinical leadership point. Yeah, I did use that for a while. But so we talked to guys and go, you know what, when I first five years of my career was in hospital service, right? So I was in five years, or the first five years, part of it was hospital service and MBT. When I added up my wage, I’d spent twice the amount of time working and I’d gained half the money of my mates that went into practice.

But I exited with a fellowship in surgery and an insight into implant dentistry and various type of things. And I think for most of my friends, I’ve made far, far more money than anybody’s made that I graduated with. Right. And I’ve been so privileged and so lucky. And that’s the funny thing because I think a lot of the people have been brought into dentistry on a promise of what they’ll make.

Yeah. And it’s harder and harder in dentistry now to make the money that they’ve been promised. And I’ve been telling that story for many years now. What I would like to say to the guys is, if you want to be really successful in dentistry, both in terms of financially and in terms of the respect you get from your peers and in terms of the satisfaction you get from your job, try and be good from the very get go.

Just try and be good because there’s always a place for good in the market. If you get close to the top 10% of the market, you will be remunerated really well. You’ll be thought of really well. You’ll have a lot of colleagues that you trust and like, and your staff will stay with you because they respect you, all of that stuff.

But if you start by trying to be rich. You’re unlikely to get good. So if you start good, you’ll probably be good and rich. But if you start trying to be rich, the likelihood is you’ll probably never be good. And what happens to guys at my age, and you’ll see it, is they get desperate to lecture or desperate to speak, or desperate to justify themselves because they’ve got enough money or a lot of money.

And then they go, but I’m not, nobody thinks I’m in. They’re isolated in a position. And the guys who are speaking, they’re really brilliant world class guys that are speaking over here are doing that. But I’ve just spent 25 years trying to be really good at what I do. And so see the young guys buy a camera, right?

Do the focus photography course, which is, I’ve got no link to that apart from it’s brilliant, isn’t it? And right. And do photography course and start photographing your work and be proud of it and realize that that building a career is building and it builds and builds and builds and don’t do anything to people that you wouldn’t do your own family. Straightforward. Brilliant. 

Interjection:
Hey guys, Jaz interjecting here. Listen to Colin. Colin is telling you, just like my mentors tell me all the time, when I was a new grad, the first thing I was taught was take photos. And it is shocking. Like obviously we see so many photos on social media, so I know lots of dentists are taking photos, but actually it’s still the minority.

It’s shocking how few dentists overall are taking photos and no, I’m not including phone photos as photos. Okay? Phone photos are not proper photos You wanna take really beautiful photos, do what Colin says. Get yourself on a photography course. There’s a lot you can learn on a hands-on course, fancy shots, studio lighting, that kind of stuff.

But if all you want is the foundations and to be able to take. A consistent series of photos, good occlusal photos, good frontal photos, wellex exposed, well framed, and I invite you to take on the 21 day photography challenge in just three weeks in videos that range from three minutes to 10 minutes, one video per day.

You can learn photography to a very good level, and then you can fly. If you choose to go on a hands-on course, the 21 Day Challenge is available on the app. Protrusive Guidance, we just literally launched it last month. It’s been great to see your portrait photos and your engagement throughout the different lessons.

I look forward to awarding you with your badges. Anyway, back to the episode. 

[Jaz]
Well, I think we’re gonna have to, I mean, I could speak to you for days and days, Colin. And, I think instead of going deep into the final thing about what is your view on selling in dentistry, but I think you have spoken about this for so long that I think you’re able to give us a post-it note version of your definition of sales in dentistry is selling.

The whole thing about is selling a dirty word. So some dentists get very upset about this topic, whereas other dentists are very proactive in saying, Hey, we sell all the time. When we speak to our spouse, we are selling an idea. That kind of stuff. We all heard that before. So what is your take and what is your advice when it comes to, ’cause I think prefix is wonderful the way you described that.

I really like that about the sort of the levels of profit versus ethics and how actually there should be a degree of balance. And I really, I’ve never heard of that. I love that. But what would you end the podcast in when it comes to sales in dentistry and have to think about it, how to approach it.

[Colin]
Well, first of all, sales is, it’s not a dirty word, but it has dirty connotations in certain places, right. So the last book that I’ll recommend if you’ve not seen it, which is a brilliant audio book, Daniel Pink ‘To Sell is Human’. Okay. It changed my world in sales because I exited the hospital service as a working in head and neck cancer going, I’m never selling to anybody.

I’m not salesman. I mean, so there’s a famous story ’cause I’m very good friends with Chris Barrow. Chris coached me for years and paid him a lot of money, took over 18 months and stuff, and he transformed our business extraordinarily and was a big, big influence on us. But when we were at early stages, we were in Jamie’s Italian restaurant, which is not a thing anymore, and we were having a chat about sales and it was lunchtime and the restaurant behind us went quiet in a moment, just at the point where Chris shouted at me, you think sales is an STD?

Right. And so I have Jaz, I’ve been on a journey, I promise, understanding that profit is oxygen for my business. Right. So use that as your intro by the way. Yeah. So profit is the profit. Profit is oxygen for my business. Get that. It’s essential for life, but it’s not the meaning of life. I do not wake up in the morning going, oh, I’m gonna get some oxygen today, but if I don’t breathe, I’m dead.

Right? So we need to profit, right? But we don’t need profit to be our, our dream, our vision, our function. We don’t have that, right? But we, so what I want to do, if you or any of your family come to see me, is I want to be able to try and give you a really good solution to your problem. If I can. If I can’t, I want to be able to tell you that I’m sorry that I can’t, but I want to be able to try to find someone who can.

That’s it. And so our business, my amazing business is expanded to the fact that so we can solution, manage a lot of scenarios, but not all of them, right? And so I want you to be able to choose a solution with us, or get the option to choose a solution with us. And I never ever want to let you down on service.

So if you come to see me. You have a consultation, we will keep talking to you until you don’t want to talk to us anymore. Not in an obsessive way, not in an angry way, but we’ll say to you, do you wanna go ahead with treatment? You go, I can’t at the moment, Colin, ’cause my son, he wants a new cricket bar and it’s gonna cost me 50 million quid.

So it’s gonna be about six months. We’ll go. Is it okay if we phone you in six months to check in? And if you go, oh, that’d be great. That’s the ideal thing. We will never miss that call. If you say to us, not just now, Colin, we’ll never call you again until you come back to us. That’s what sales is like.

Never let people down because you’re too busy. Never break a promise. Never ever contact someone who does not want to be contacted. And so if you do that and you count it, if you follow the consultation process that I shared with you, right. My conversion rate is still, it’s about the only thing I’ve got left in the practice that I’m good at is still 80% or above.

Right. If you come to me, if your wife fell off her bike tomorrow and she lost her upper central incisor and she has a large smile and that’s important to you, it’s close to 9,000 pounds for me to replace that tooth. And my conversion rate is 80%. The process works extraordinarily well, but that’s because we are trusted and we’ve developed trust over 27 years worth of practice in this area.

[Jaz]
As Raj Rattan, you say trust is something that you, you build in like drops or ounces and you can lose in bucket loads in a minute. 

[Colin]
So in a minute. People can’t understand if they talk about marketing Jaz and they can’t understand why they can’t attract patients because they don’t have a brand, because they don’t know what a brand is.

[Jaz]
Beautiful. Colin, I thoroughly, enjoy this. Part of my duties on the podcast is, I’ll give you some context, Colin. I’ve been doing this podcast since like 2018, 2019 now. So we’ve got, hundreds of hours and whatnot, and it’s been absolutely, one of my favorite things to do still is having these conversations, the most wonderful conversation we just had.

But I have a responsibility that early on in my podcasting career, some people used to message me. It always stuck with me. What stuck with me, and they said like, Jaz, you are giving everything away for free. Like on the podcast, everything is being given away for free. And these course providers must hate you because you are literally giving away everything free.

But actually that dentist, a dentist was wrong. Because what I’ve found is that actually through Protrusive, I have connected dentists and listeners to educators that they really resonated with and they never was on their radar before. Or, help them to connect with someone that, you know what, I like this chap.

And I think there definitely, I think a lot of people would’ve resonated with you. Some people might hate your guts based on your views on composites. And that’s okay as well. But for those who resonated with you, can you tell us about the Colin, the Campbell Academy, I believe it’s called What You Teach.

And I’ll definitely put the website and everything in the link as a thank you for giving up your time, but also to, as a responsibility, I have to help everyone grow because the podcast is one thing. And yes, we do CPD, but to be able to grow and do the kind of procedures is important for me to connect them with educators.

[Colin]
So listen, first of all, when I grow up, I want to be you, right? And so you are doing extraordinary, extraordinary work here, and it’s a brilliant thing you’re doing and never stop, right? And your enthusiasm’s fantastic. And it’s been a privilege to be asked to be here. I don’t need to promote anything, it’s just been a privilege to talk, right?

[Jaz]
Thank you. 

[Colin]
If you wanna find me, we are the Campbell Clinic Group, right? The Campbell Clinic is this, we purpose built a 7,000 square foot, specialist practice, whatever you call it. We educate, we research, we teach, the why of our business is we positive. We exist a positively influence a life of as many people as possible through the work that we do.

In the example that we set, if you like that connect, go to Campbell Clinic, wherever you want on all your stuff, or go to the Campbell Academy. The Campbell Academy educates dental business and dental implants. And is, and is, is going like a rocket in lots of different places. And all of the chat that you get here is what you get.

When we educate, we chat about this stuff all the time. What you get beyond our education is the philosophy, how to practice and what to do. And, and we have a tribe of people who subscribe to that. And we have a lot of people who probably hate it. The other place says, if you like the conversation, I write a blog.

So my podcast is a blog. I have a podcast, but it’s stalled. But, I write a blog and I’m now at 4,250 posts. It’s been every single day for what? 15 years. 

[Jaz]
Wow. Well you’ve been blogging every single day? 

[Colin]
Yeah. And so if you go to Colin Campbell blog, you’ll find that subscribe. You’ll get it, it goes every single day. So there’s a business, a separate business one. 

[Jaz]
And I definitely will be. I’ll definitely put that link. That’s brilliant. And I’ll definitely put the link for the academy and promote all the good work you do. 

[Colin]
Yeah. Listen, honestly, I knew through the week I was looking forward to talking to you and that was a real privilege. I’m so glad I had the opportunity and thank you so much for your time. 

[Jaz]
It means so much to me. Thanks you so much, Colin. I appreciate your time. And we should do this again sometime. 

[Colin]
Whenever you’re like, gimme a shout. See you later. Cheers. 

Jaz’s Outro:
Well, there we have it guys. I told you it’s a saucy one. I told you it’s a little bit spicy, controversial.

Sorry, but not sorry. I think you just did a brilliant job. Don’t you Just love Colin, and just before you think this couldn’t get any better, you can get CPD for this episode. Answer the quiz, get 80%, and you can get CPD. This is available for all our paying subscribers on Protrusive Guidance. And maybe now if you’re not already on the app, it is time to join us and upgrade.

Head over to protrusive.co.uk/ultimate and unlock CPD. That’s enjoyable, inspiring, and actually we’ve got tons of masterclasses there as well. Protrusive education is a pace approved provider. I’m gonna take a moment to thank team Protrusive for all their hard work. And thank you once again. Dear listener, you joining me on this podcast just means so much.

And if I can just ask you, just click that button, hit that subscribe button. Honestly, it would mean a lot. So please do that. And in doing so, I’ll catch you same time, same place next week. Bye for now.