The Best Practices Show with Kirk Behrendt

Do I Know That My Patient is Comfortably Numb?

Episode #341 with Tom Viola, R.Ph., C.C.P.

Hello? Is there anybody in there? When it comes to ensuring that your patients are comfortably numb, there’s a lot to consider—it’s much more than just a little pinprick. Tom Viola joins Kirk Behrendt today to discuss the different types of anesthetic agents and how to improve the implementation of anesthesia in your practice. To find out how to ease your patients’ pain and get them on their feet again, listen to Episode 341 of The Best Practices Show! 

Main Takeaways:

When patients wait to seek dental care, it results in more pain.

Novocain is typically considered the most common anesthetic, but almost no one uses it anymore. 

Different anesthetic agents are metabolized by the body in different ways.

There’s no one size fits all solution when it comes to anesthetic agents—the patient’s medical history and condition can rule out the use of certain agents.

Perfecting anesthesia isn’t something that happens in the classroom—it takes time and practice.

Quotes:

“It’s tough for dental professionals to take pharmacology and make it applicable and practical to their everyday practice.” (04:46—04:54)

“My job is to make this whole world of pharmacology fit into bite-sized pieces that you can use to get better outcomes for your patients.” (05:47—05:56)

“The reason is all about one thing—pain. Pain is a demotivator and a motivator for our patients.” (07:26—07:33)

“If we can get that pain to be not a bad memory, but an ‘Ehh’ memory, then they won’t be so fearful next time, and they’ll come back sooner, and we won’t have this vicious cycle of pain being a demotivator and actually making the situation worse over time.” (09:49—10:05)

“I can never teach anyone technique and accuracy because those are the skills you hone in years of clinical practice.” (10:42—10:50)

“Am I using the right anesthetic agent for this patient based on their particular medical history and what medical complications they may have?” (12:25—12:36)

“It’s all about the type of anesthetic agent and making sure the patient understands that the anesthetic agents we’re using, for the most part, are honed to perfection based on their specific needs.” (16:17—16:30)

“If my expectation is I should be numb in a minute, and I’m not numb after five, I’m not blaming the anesthetic agent—I’m blaming you.” (20:56—21:04)

“Just make sure of the selected agents you chose to be your favorites, you’ve got enough to cover every patient with every specific or individual type of medical complication.” (35:02—35:12)

“While Prilocaine may be an amazing agent, this methemoglobinemia thing stands in the way of a lot of clinicians warming up to it.” (37:30—37:38)

“I guess my greatest advice is don’t be stuck with one [topical] because again, based on the procedure and the patient, you may want to decide to use a different topical versus one size fits all for all your patients.” (41:40—41:53)

“When in doubt, always, always take what you’ve learned in podcasts like this and courses like mine you can take, and realize that you’re the clinician.” (42:13—42:25)

“Do your own research and come up with what you think—based on what I’ve said—is the right strategy for you, because not every anesthetic fits every patient.” (42:42—42:52)

Snippets:

Who is Tom Viola? (03:12—05:57)

Why is this important? (07:16—09:59)

Challenges of anesthesia. (10:24—13:22)

A variety of anesthetic agents. (13:36—16:30)

Advantages and disadvantages of agents. (16:43—24:57)

Lidocaine vs. Mepivacaine. (25:06—35:12)

Prilocaine and Bupivacaine. (35:38—39:03)

Topicals. (39:04—41:53)

Final thoughts....

Digital Implant Dentistry

Episode #340 with Dr. Mark Ludlow

If there's any way digital can elevate your practice, use it! Today’s guest, Dr. Mark Ludlow, is here to talk about the benefits of digital implant dentistry and its future. Kirk Behrendt and Dr. Ludlow examine the different ways using digital can help students, dentists, and their patients. If you're interested in what digital could do for your practice, listen to Episode 340 of The Best Practices Show!

Main Takeaways:

Digital doesn't replace fundamental dentistry; it’s a tool.

Digital is objective, and can also help students get more practice.

Using digital can positively change the patient experience.

It can also cut down chair time with the patients.

Analyze how digital can fit into your practice.

Quotes:

“I've been doing this stuff for quite a while, just because it was something that interested me, and it was something that I saw as moving into the future and what would be the future trends of dentistry. And so, that's why I hopped on it earlier. And looking at it now versus how it was back then, it’s almost unrecognizable how different it is now.” (04:45—05:06)

“A lot of what we do in prosthodontics is we’re coming in, sometimes to fix things, sometimes to redo cases, and stuff like that. And so, you really want the tried-and-true thing to constantly work, and something that's always worked and has worked over the years and has big history. And sometimes, that's a little bit difficult when it comes to digital, because hardware changes, software changes, different things change so quickly.” (07:31—08:00)

“There are so many things that you can do with digital that back in the day I couldn't even really fathom doing.” (08:45—08:53)

“I think the one thing people have to remember is, what digital does for you is it doesn't replace fundamental principles and fundamental dentistry. They're tools, just like everything else is a tool. (09:23—09:34)

“I think what a lot of these [digital] tools do for us is it allows the student, especially, to start really being able to self-evaluate, because the scanner and the software to merge it, it’s just a tool. It’s going to give them a completely objective readout to where they can start to look at things and really self-assess and see, ‘Okay. This is what I'm doing. This is what I need to do better.’” (11:57— 12:23)

“[Digital] is not getting feedback from the faculty that may look at it and be like, ‘Ugh, this stinks!’ And you go to the other faculty and they're like, ‘This is the greatest prep we’ve ever seen!’ Digital doesn't do that at all. It’s completely objective. It says, ‘Well, you were off 500 microns here, a millimeter-and-a-half this way. You were completely off.’ So, it really helps the students.” (12:24—12:46)

“Before, in labs, you had to sit there and prep, and do your thing, and have the faculty be there. Now, they can go ahead and do this any time. So, the kids are getting a lot more practice than they normally would because they can get the feedback off-hours and get more experience that way.” (12:49—13:07)

“If there's some way that digital could augment your practice, get into it.” (29:08—29:14)

Snippets:

Dr. Ludlow’s background. (03:05—07:01)

Old and new-school prosthodontics. (07:25—10:05)

Benefits of digital for students. (10:42—13:39)

The digital side of implants. (14:27—17:47)

Changes in digital. (18:31—20:09)

What dentists and students get wrong with digital. (20:17—22:00)

The future of digital. (22:14—25:11)

Favorite thing about working with students. (25:30—28:46)

Last thoughts and Dr. Ludlow’s contact information. (28:57—30:53)

Reach Out to Dr. Ludlow:

Dr. Ludlow’s email:

Leadership is Lonely

Episode # 339 with Dr. Barrett Straub

Something that no one warns you about is the fact that leadership—and dentistry as a whole—can be lonely. A leader has a great deal of responsibility, and if not properly managed, you can find yourself burnt out. Today, Dr. Barrett Straub joins Kirk Behrendt to discuss their experiences with leadership in the dental field. To learn how you can overcome the loneliness and become a better leader, listen to Episode 339 of The Best Practices Show!

Main Takeaways:

Look to your mentors and peers for advice on how to grow as a leader.

The people you surround yourself with have a large impact on who you are.

Keep an eye on what you consume—too much negativity will adversely affect you.

Other dentists undergo the same challenges as you—you are not alone.

Not only will ACT Dental University provide you with knowledge from the top minds in the dental field, but it will also make you a part of a community and support group that wants to help you live a better life.

Quotes:

“It’s unique and unlike any other business leader in the world in that, as a dentist, you are not only the CEO, but you’re the manufacturing line.”  (01:30-01:40)

“It is lonely when you are responsible for running the business, responsible for thinking smart, thinking strategically, and responsible for producing the revenue.” (01:45-01:55)

“In a normal business you can sit down with your leadership team and strategically think through some solutions and implement change—it’s hard for a dentist because we don’t have the time or luxury necessarily to sit down and figure stuff out, because we’re doing dentistry all day.” (03:38-03:52)

“One of the things that slows you down is when you wake up and you’re not living your core values.” (04:54-04:59)

“One of the most important things that you have to do is you have to experience yourself the way your value system is telling you to go in dentistry, and that’s when you wake up.” (05:22-05:31)

“If you’re listening and you’re like ‘I care about my team, I’m a life-long learner, but it’s just not getting better…’ you have to make it better. You have to, or else what you start to do is you start to give up, you start to lose that energy, and we don’t want that to happen.” (06:26-06:42)

“I came out of dental school thinking ‘I’m gonna be a great leader, I’m just born for this—I’m gonna kill it.’ And what I found out really quickly was I wasn’t a great leader, and it’s really, really hard. And holding leadership positions is way different than being a leader in a dental practice or a small business because now you’re dealing with real people and real emotions, and real-life challenges that affect your day-to-day operations of your business.” (07:27-07:57)

“You don’t need to bring in a partner to have community.” (11:07-11:12)

“I think it’s really important as dentists you have a safe place to go where you can be vulnerable.” (12:16-12:23)

“Yes, leadership is a risk, and it is lonely, and it is hard. And it’s totally worth it. To be a leader and be able to bring people up and improve their lives and help them do things they never thought they’d be able to do before—there’s no greater rush in life than to do that.” (13:22-13:42)

“Your problems are how you think about the problems—everything you have is a thinking problem.” (15:45-15:51)

“The only thing that separates you from them is how you think.” (16:24-16:28)

“I always love a hug from a great client, but what’s more fun was watching clients hug other clients, saying, ‘We gotta stay connected.’”...

Digital Workflow, Telemedicine & Working from Home

Episode #338 with Dr. Larry Emmott

For many dentists, 2020 forced them to use digital technology to maintain their practice from afar. However, for Dr. Larry Emmott, embracing the benefits of the digital workflow has long been his way of life. Dr. Emmott joins Kirk Behrendt today to explain the steps you should take to streamline your practice and give yourself more time. To learn how utilizing technology will make your practice more efficient and profitable, listen to Episode 338 of The Best Practices Show!

Main Takeaways:

We take our access to technology for granted.

Digital workflow lets you use your digital records to do things differently.

People have always resisted change—don’t let that stop you from improving your practice.

Have staff members understand that technology is not an extra step—it’s just the way things need to be done.

Embracing technology will increase your profitability by reducing the number of staff members required.

There’s so much that staff members can do from home.

Streamline your practice by using technology to implement electronic systems—this will give you more time.

Quotes:

“Have people understand that technology isn’t something extra—it’s actually what makes your practice thrive.” (02:52-02:57)

“Many of the things which we do now that allows us to do this—to have school from home, to work from home, to communicate, to stream movies from Netflix—all of that stuff has to do with the infrastructure of the high-tech world we now live in. If we had been faced with this same issue just twenty years ago in the 1990s, it would have been completely different; we wouldn’t have been able to do all the things that we do.” (04:44-05:10)

“Up until 2020, I was basically teaching people how I could streamline the flow of work in the dental office, but the fact is that because it’s electronic and digital I can do this same work not in the office.” (07:57-08:13)

“People resist change because it threatens their self-image, and they fear loss of status.” (11:54-12:00)

“One of the things I want the dentist and the staff to understand is that when you’re dealing with change, those are the things that you have to deal with; there’s more psychological stuff, and so helping support them, helping to make sure they’ll be valuable—in fact more valuable—after the transition I think is important.” (12:31-12:48)

“If you have good electronic systems, you can do more with fewer people.” (13:38-13:46)

“The so-called crisis isn’t in healthcare—it’s not the care. We have amazingly good care for the most part. The crisis is in affordability—it just costs too darn much money to get sick in America…Telemedicine will allow us to do things in a more affordable way.” (19:52-20:20)

“That was the way you used to have to do it; so it involved a human being getting data, which was paper charts and paper schedules; doing an action, which was making my phone call; to come out with a result, which was the confirmation of appointment…So what we do now is the computer gets the data in the form of the patient’s information…it goes up to the cloud to some cloud computer, it sorts it out, it sends a text message that comes out of my phone back to the patient saying ‘See you tomorrow at 2:30,’ and it does it every day with every patient, with no person ever picking up a telephone.” (23:57-24:44)

“Every time you create a system or put in a technology, you save hundreds—if not thousands—of hours in the future.” (31:25-31:34)

“Our best doctors that had their team members [come] back did the best effort they could daily to truly educate their team on what the

Critical Steps to Fun & Predictable Dentistry 

Episode #337 with Dr. Glenn DuPont

Dentistry should be a fun, profitable, and predictable career. But for many young professionals coming out of dental school, this isn’t the case, and their practice can become overwhelming and stressful. Kirk Behrendt is joined by Dr. Glenn DuPont to talk about the critical steps to ensure that your patients love you and the work you do, while maintaining a strong business. To learn the best practices you should take to grow a practice that is predictable and profitable, listen to Episode 337 of The Best Practices Show! 

Main Takeaways:

Spend time early on with a patient making a diagnosis and treatment plan.

Rethink your approach to solving a case.

Unpredictable things happening in your practice should be rare.

The goal is to have a patient love you and the work you do on them.

Don’t overlook problem when they arise.

If you’re feeling disillusioned with dentistry, reach out and find a good mentor.

Quotes:

“I talked with a classmate recently who’s ready to retire. And he was saying that some of these younger dentists just don't understand that a nice, profitable, relaxed practice is possible. They wonder why he’s not busier. And his answer is, ‘Because I don't want to be busier. I'm making a great profit.’” (04:42—05:03)

“I think dentists need two things. They need someone to manage their staff and their practice like [ACT Dental]. But I think one of the things that we haven't done so good in is helping dentists manage and practice their cases so that they are profitable and predictable.” (05:09—05:29)

“I think [students] get out of dental school and maybe they're in a corporate type of format or a dentist who runs a very high-volume practice. And in dental school, you're not doing high volume. And all of a sudden, you get thrown into this, and it’s not what they thought. It’s not what they expected. And that's why dentists come to The Dawson Academy and come to us a lot of times, get me involved with them, is that they know there's a better way.” (08:02—08:38)

“I had a dentist, a classmate of mine, call me after ten years he was out. And he said, ‘I got great patients. I'm in a nice little town in Georgia. I'm a member of the country club. My kids to go private school. And I hate it.’ I said, ‘Why do you hate it?’ He said, ‘Because my practice is running me. I got out of dental school and all I knew was how to get busy. I didn't know how to get busy in the right way.’” (08:57—09:26)

“We all run into the same problems in dentistry; it’s how we solve them. It’s the thought process and solving them.” (10:56—11:03)

“Think of a restorative case, and let's think of it backwards than what you typically see presented. So, where do we want the end to be? We want the end to be that patient smiling, saying, It’s great and it feels good. My bite feels good. My speech,’ loves everything about what you did, and for that reason, loves you. That's the ending I want. And that's what makes us feel great. Yeah, we get profit. We have to have a profit. But that is what we work for.” (11:40—12:28)

“I think the number-one mistake [dentists] make is not spending the time to diagnose and treatment plan. Pete Dawson would say the most important appointment we spend with the patient is the exam, and then the most important time we spend is our working on the models to determine what's wrong and what we’re going to do.” (19:26—19:55)

“I think the biggest problem is, dentists think spending time treatment planning is lost revenue. And it’s not, because you will find more work to do and you'll do longer appointments, so you're going to be more profitable.” (20:13—20:33)

“The one thing that dentists have trouble with — not the biggest problem — I think the main thing...

How the Face is Supposed to Work

Episode #336 with Dr. Michael Gunson

Faces have multiple functions. It needs to breathe, eat, and communicate. But while a face may excel at these tasks, it may not be aesthetically pleasing — and vice versa. And to talk about how to achieve a functional and aesthetic result with treatment, Kirk Behrendt brings in Dr. Michael Gunson from Spear Education to teach you how the face works and how to redefine normal. For the best practices on treating the face for form and function, listen to Episode 336 of The Best Practices Show!

Main Takeaways:

The face has three key functions: to breathe, eat, and communicate.

Understand why something looks good in a particular location.

“Normal” is just the average of what has ever been observed.

Using standardized normals won't always make a face aesthetic.

Understanding why something looks good will help you adjust for people who are not “normal.”

Connect with patients. Help them understand the problem, and they will accept treatment.

Quotes:

“My partner was at the forefront of figuring out how to move the teeth and jaws in a way that's aesthetic for the face. Because prior to him, for the most part, people were just going by cephalometric normals or, ‘Let's just put the teeth together, and that'll make a good face.’ And that was not true. So, he devised a way of measuring and treating the face aesthetically. But as I did that, I discovered you don't always hit the bullseye going by these standardized “normals.” And what I started to discover is that “normal” is a bad word. None of us should be trying to make anything normal. Normal is just the average of what has ever been observed.” (07:17—08:14)

“My partner, Dr. Arnett, says, ‘Put the chin here. This is the location where the chin belongs.’ So, I started asking questions like, ‘Well, why? Why does the chin belong there? Why does that look good?’ Because if I understand the why behind it, then I can make adjustments for people who are “not normal” or not underneath the bell curve. So, I started asking all these “why” questions.” (09:59—10:26)

“There are some functional keys to the face. In other words, the face has a job to do, and that job is to do three main things: the face needs to eat, it needs to communicate, and it needs to breathe. And what I discovered looking at all kinds of data, all kinds of articles, is that the brain is in charge, and the brain will override just about any aspect of the face in order to accomplish those three goals. So, does the brain care that the teeth wear down when somebody chews or talks? No. The brain only cares that we eat and that we communicate. Does the brain care that posture can be deformed in the neck and hurt if growth is incorrect? No, the brain doesn't care if the neck hurts. The brain’s actually responsible for the neck hurting as the patient cocks their head forward, has bad posture, in order to breathe.” (10:32—11:46)

“In me speaking with my patients and having a connection with my patients, I felt like I was not connecting with them based on, ‘Oh, let me just explain to you that your jaw is in the wrong place, and we need to put it in the right place.’ And the patient’s like, ‘Okay?’ So, the patient has to believe me, at that point. That's far different than sitting with a patient and listening to them, ‘Well, what is the problem?’ ‘Well, my neck hurts. My jaw hurts here. My mom’s always yelling at me to stand up straight. I drool.’ It’s like, ‘Yeah. I'm sorry you're going through that. Do you want to know why you're doing those things?’” (13:03—13:52)

“I'm connecting with the patient’s story. This is their life story, and I'm connecting with their life story, and they're feeling me connect with that. They're feeling me understand that life story so that now we’re on this same level;...

Post-Covid vs. Peri-Covid

Episode #335 with Dr. Kevin Kwiecien

If you’ve needed an excuse to make changes to your practice, now is the perfect time! Covid-19 brought with it many tragedies, but also opportunities. To offer some perspective on what this means for dentists, Kirk Behrendt brings in Dr. Kevin Kwiecien from The Pankey Institute to reflect on this past year of the pandemic. He explains some of the benefits of this time that he calls peri-Covid, and also reminds us that we are not post-Covid just yet! To hear about the changes you can make and why now is the best time for them, listen to Episode 335 of The Best Practices Show!

Main Takeaways:

As of today, we are still not post-Covid. We are very peri-Covid.

Peri-Covid is an opportunity to talk about health.

It’s also an opportunity to make changes to your practice. 

Patients are more amenable to change during peri-Covid. Use this to your advantage!

Practice the three P’s: predictability, progress, and purpose.

Quotes:

“If you've been pregnant, or have a partner who’s been pregnant, or anybody in the world that's been pregnant, we talk about prenatal vitamins, prenatal care, prenatal this. Then, we’ve got postnatal as you're healing. Even if you look at Peloton right now, they’ve got postnatal yoga and things like that. And, of course, when you're pregnant, you are perinatal. And people always say “post-Covid.” And I'm like, no. There was pre-Covid. We certainly haven't hit post-Covid yet. We’re now over a year-and-a-half peri-Covid. And we thought we were getting to post-Covid, but we’re still quite peri-Covid.” (07:34—08:12)

“People thinking, ‘Oh, no. We’re post-Covid now,’ I'm like, it’s a different mentality. You're still in it, and what does that look like for you? When you're pregnant the first month, it feels one way and you like being pregnant. And probably, when the pandemic started, some of you liked the Netflix binging and the forced hanging out at home, especially after you got the PPP loan and the EIDL loan. But then, when you're in your seventh month of pregnancy, you're like, ‘Have I not had this kid yet?’ And now, we’re in the — I don't even know what month we’re at — 16, 17, 18 months of being pregnant with Covid, and we’re all ready to be post-Covid. But we’re not. We’re still peri-Covid.” (08:17—09:03)

“This peri-Covid time that we’re in in the 18th month of pregnancy, the pressure is still there. And it might even be worse because we feel like we’re close to the end, and yet there are dentists who are still looking for associates. Most dentists right now are looking for team members. That's the biggest stress right now across the country, how do you find a good team member right now. It’s that scarcity mentality right now. It’s, you don't have to be in scarcity mentality, but how do you realize that you're in scarcity mentality, how do you manage it, and how do you move on with hope and abundance mentality versus scarcity mentality. And that's a lot of the conversations we’re having lately.” (11:01—11:56)

“There's a reason that we decide how we want energy and information to flow through the office. As I say, how energy and information flows through the office optimally with intention. We've decided how that looks for us so that when there's a little glitch, we still know what optimal looks like. That's predictability, but it takes work. And the progress, for me, it’s every day, what is the small little shift, the tiniest thing that you can do so that you don't do exactly what you did yesterday. What's the teeniest, tiniest, shift? Because that's progress.” (16:47—17:27)

“A lot of practices, I'm guessing it’s the majority, meaning over 50%, if they look at their checkbook, pre-Covid, and they look at their checkbook now, it’s probably more now. And so, they had...

What is Your Practice “IT” Factor?

Episode #334 with Dr. Michelle Lee

Differentiating your practice is one of the most important things you can do. But just being unique isn't enough. You still need the “secret sauce” to put that uniqueness into practice. And to help you find and apply your own “it” factor, Kirk Behrendt brings in Dr. Michelle Lee from the Pankey Institute to share the philosophies she learned from the organization. For Dr. Lee, focusing on relationships and the patient experience is what helped her practice thrive. To hear her advice on finding your unique “it” factor, listen to Episode 334 of The Best Practices Show!

Main Takeaways:

Differentiate yourself through practice philosophy, different services, or patient experience.

Relationships are part of the “it” factor. Cultivate relationships with your team and your patients.

Differentiating your practice can positively impact your team.

Start small with team meetings. Don't tell your team to do it — invite them.

The Pankey Institute provides a template for the “it” factor, as well as a life/dental compass.

They will also help you bridge the gap between what you know and how you practice it.

Practice gratitude and mindfulness with yourself, your team, and your patients.

Quotes:

“Dr. Pankey had a practicing philosophy construct. He said you need to know yourself, you have to know your work, you have to know your patient, and you have to apply that knowledge.” (09:21—09:38)

“All patients come with a story, just like I have my story. All patients come with different circumstances. They have objectives and they have different temperaments. How do we begin to know our patient, that practice philosophy piece, if we’re not able to spend the time with them?” (13:35—13:52)

“My differentiation in my practice is that comprehensive exam, is really fully understanding where the patients are coming from to then fully understand what kind of treatment plan we’re going to go to, and then executing that. But that execution piece is also that technical piece, that I think patients appreciate the communication, the philosophy, and understanding what their circumstances may be.” (15:07—15:35)

“My heart just goes back to gratitude every day — and my team. I wouldn't be here if it weren't for my team. I'm the last person that patients meet when they enter the practice, and so to be able to have that culture where all of our hands are on the rope and we’re pulling in the same direction, I always say that it takes a village. And I really appreciate the gifts that my team shares with me.” (17:03—17:32)

“Speaking personally for myself, the type of practice that I have is a fee-for-service, out-of-network practice. And so, that is the only way that I feel like my practice can thrive, is to differentiate [myself], whether it’s through a practice philosophy or, at least for me, having different services for the patients, or creating a new patient experience.” (18:10—18:45)

“A couple differentiations that I have is, all patients in our practice get a tour. Just like if you were a guest in my home, I would invite you in and I'm going to walk you through, and I'm going to tell you where things are. And we’re really going to thank you. We really thank our patients for coming into our practice. Everyone puts down what they're doing. I'm going to say pre-Covid days — now, it’s a really big smile with my eyes with my mask on. But we really welcome our patients to the practice, and we thank them for being there. So, we really warmly welcome them.” (18:47—19:23)

“The other thing that we do is just that experience. I always say I don't like to treat strangers. But once we meet, and once we have this new patient exam together and this thorough exam, we will no longer be...

It Can't All Be Done With a Bur

Episode #333 with Dr. Jeff Rouse

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

Main Takeaways:

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

Dentofacial growth problems need to be addressed, not camouflaged.

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

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

Comprehensive care isn't taught in dental school.

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

Quotes:

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

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

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

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

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

Up in Smoke: Will Cannabis Replace Analgesics in Dental Pain Management?

Episode #332 with Dr. Tom Viola, R.Ph., C.C.P.

You might know that one person who really loves their mints. But it turns out, those could be edible cannabis, not Altoids or Tic Tacs! And because so many different forms are available today, it’s almost impossible to know who could be using cannabis. So, why is this important to dentistry? To answer that question, Kirk Behrendt brings back Dr. Tom Viola to explain some of the direct and indirect impacts, as well as some of the ethical dilemmas of cannabis. To learn what dental school didn't teach you about cannabis, listen to Episode 332 of The Best Practices Show!

Main Takeaways:

Cannabis is still an unknown, and its use has an impact on dentistry.

There are many myths and misconceptions about cannabis.

Cannabis actually raises your blood pressure and heart rate.

In high enough doses, cannabis can increase anxiety.

Cannabis can cause immunosuppression and increased risk of infection.

Patients who use cannabis are more resistant to the effects of anesthetics.

Because cannabis isn't standardized, we don't know how much a patient may be taking.

Cannabis can span any age group. It’s not just younger people taking it.  

Always ask patients about their cannabis use.

Quotes:

“Cannabis is an unknown. I didn't learn about it in school, you didn't learn about it in school, because at the time, cannabis was still a Schedule I substance under the federal law, which meant it was illegal, like heroin, like LSD. So, we didn't learn much about it, and we really didn't anticipate that cannabis was going to get such widespread political and social acceptance — and medical acceptance — as it has now. Honestly, it’s still a quagmire. It’s still illegal, Schedule I, at the federal level, but approved in, if you want to call it that, or legalized or decriminalized in 35 states throughout the country. So, it leaves everybody in a quandary because, again, your patients have never had such widespread access to a drug that we, in our education, never really learned much about.” (07:50—08:37)

“The first thing you need to know as a dental professional is that what your patient is smoking, consuming as a gummy, vaping, is probably not one of the three original strains but some hybrid of those three strains that specializes in a specific THC or CBD content that the patient is demanding or the patient expects.” (14:57—15:17)

“The next thing to realize is that many people believe that cannabis, marijuana, mellows you out. And therefore, by logical extension of “mellows you out,” that means it must lower your blood pressure, lower your heart rate, make you calm and less anxious. Actually, that's not true. Actually, cannabis raises blood pressure and raises heart rate, and in high enough doses can actually cause paradoxical effects of dysphoria, anxiety, agitation.” (15:21—15:54)

“From our perspective as dental professionals, it’s like, ‘Yeah, you're right. If you can use cannabis, why do we need to prescribe an opioid? I'm good with that too.’ But if you look at the legislation in all these states where opioid education is mandatory, what's one of the primary things that’s central to all of those education programs? Did you educate the patient? Did you ask an at-risk patient one question: do you have, or have you had, an issue with substances in your past? And guess what? Cannabis is a substance. Your patient may not agree with it. Heck, you may not agree with it. But at the end of the day, it is. So, all of a sudden, it’s easy for the patient to say, ‘Hey, don't worry about it, doc. I had a gummy an hour ago. I'm good.’ But is that substance abuse?” (18:39—19:28)

“The big question is about how to take a good medical history. The fourth...