AME: Radical Consent and the Lost Art of Tooth Preservation

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[00:01:58] [SPEAKER_00] Alan Mead is a dentist with too much time on his hands and too much recording equipment in his basement. Armed with an obsession to bring entertaining and informative content to the dental world in a way that's never been done before. I give you the Alan Mead Experience. Well, hello and welcome to another episode of the Alan Mead Experience. I'm your host, Dr. Alan Mead.

[00:02:23] [SPEAKER_00] I'm a dentist, a podcaster, and a very satisfied customer of the 2026 BioClear Alumni Summit. I don't know if they call it the Alumni Summit, but that's what it is. It's an alumni summit. It's a get-together, every couple years, of BioClear alumni. They get together and talk about lots of stuff. It's great. It's a great meeting. It's a really good meeting. It's fun to go into a place where you already know

[00:02:51] [SPEAKER_00] you have quite a bit in common with the people that are going to be there because we're all BioClear people and we've taken the courses and we've used the materials and kind of... So it's cool. Anyhow, it was a great meeting. I got lots to talk about for that. First, I just wanted to let you know from last week. I was sort of wondering about, is podcasting dead? Is this the way forward? I got some feedback from listeners and I guess I'm just going to address it right now. I think...

[00:03:22] [SPEAKER_00] People were saying they really didn't like the reruns. I always felt like, oh man, I have a lot of old episodes that are kind of evergreen and I would put those in place. When we didn't have a new, very clinical episode on a Tuesday or something like that, I would put a rerun in there to have content in there. What I'm hearing is that people would prefer no content than old content and I'm okay with that. So my new policy is going to be, I'm just putting new stuff out and if

[00:03:50] [SPEAKER_00] I don't have a new episode out, I'm just not going to put it out. Now, if someone's listening to this, it goes, no, no, no. I'd rather have the reruns. I want to hear about it because basically the only feedback I got was that people don't want the rerun. And then also, people said they didn't really care for the AME or the monologue or they didn't find... So that's great. Here's the thing. I'm only going to put a monologue out when I'm inspired too. I won't feel obliged to make one if

[00:04:16] [SPEAKER_00] I don't have the inspiration necessarily. So that's all I'm going to say about that. I have lots of new content coming out and I guess what I'm saying is I'm not going to put reruns out anymore because if I don't need to, I don't need to pad my numbers and I don't need to, if people aren't liking it that much, then I think, you know, and people are looking at it there. Some people said actually they were going to, they might stop listening to the podcast if I keep putting reruns out. So I'm kind of like,

[00:04:41] [SPEAKER_00] okay, I'm, I don't need to. And, and if people prefer not, that's okay with me. So that's all there is to it. The Alan Mead experience is personal, is personal commentary and just kind of like raw feelings on my end. If you're not interested in listening to the monologue, know that that's pretty much what those episodes are. So you could skip those as well. So that, that's all I'm going to say about that. So I, this summit was really good. It was really good. I, I, I met some new friends that I've known

[00:05:10] [SPEAKER_00] online for a while. I, I obviously talked with lots of old friends because I've been doing the bio clear thing for a long time. And actually the podcast has sort of been engaging with bio clear for a long time. And of course, Dr. David Clark was there and he was the, he was the, the life of the party, the head of the show. He, he spoke, but, but mostly he had a lot of other people speaking and frankly, they were all, it was quite good. It was sort of, sort of really good speakers packed top to bottom.

[00:05:37] [SPEAKER_00] And interestingly, I was invited to come speak and I figured what, what I'm known for and what, what I, what I know about is, is a pod podcasting round tables, that sort of thing. So that's what I did. We did a live podcast with three guests, Dr. Josh Solomon, the one and only Dr. Artie Volker, who I actually had dinner with two nights in a row too, and just dropped off at the airport. So

[00:06:03] [SPEAKER_00] what a good guy, literally say you couldn't find a better guy in the whole world. And what a good friend. And also Dr. Laura Mock, who I've, I've known for a while, hadn't had her on before. She was great. So we did a, we did a kind of a panel just talking, talking a little bit of a bit about, you know, how our, our, I called it our bio clear origin stories. And then also it's sort of our take on minimally invasive dentistry and how it's affected different things. It was pretty good.

[00:06:30] [SPEAKER_00] I was pretty happy with it. Josh Solomon is a pediatric dentist. He does a ton of teaching with bio clear. And he's really, he's kind of as a, as a pediatric dentist doing all the restorative stuff he does where he really doesn't do a lot of the classic pediatric dental stuff. Cause he does a lot of bio clear overlays and, and posterior restorations instead of stainless steel crowns, which is very, very wild and crazy in the pediatric dental dental space. So it was great. We had a,

[00:06:57] [SPEAKER_00] we had a good time. It was a good podcast and I'll be getting that to you. I attempted to record it with some of my own gear kind of last second and it didn't work, but my understanding is they actually recorded a video and audio of it. So I should be able to, I should be able to get that to you, but, but don't you worry. I also got five or six really good interviews as well. That I, so I got new content for the very dental podcast for, for a while here from the, the,

[00:07:24] [SPEAKER_00] the meeting. So I'm real happy about that. It's great meeting. I'm sitting here in my hotel room in Scottsdale. I got to get up real early in the morning to go to the airport, but I thought I would record this real quick because I had some thoughts today. Um, two of the lecturers that really kind of made me think hard about, about this topic were Dr. Raphael Bustamante and Dr. Marco Maialino. Now I didn't get a chance to talk to, to Raphael specifically, although I will, he's really

[00:07:52] [SPEAKER_00] funny. He's, he's clever. He's really funny. He's a great dentist and actually a really good lecturer. He was one of the instructors that I took, uh, the, the four day course when I was in, in Tacoma last November, he was one of the instructors. He's very good. Uh, and he gave a lecture today and, and it was a lecture when, when a crown just wouldn't do. And in what's funny about it was it wasn't because he didn't want a crown. It was because literally what do you do

[00:08:18] [SPEAKER_00] with a tooth that has so little tooth structure and is so compromised that like putting like literally by the time you, you prepared it for a crown, there's nothing left to hold onto. So it's like, it was, it was really, it was really cool. And the funny thing is, is he showed some cases that most mere mortals would look at and go, that's an unrestorable tooth. And he's, he was showing what he did in the recalls and, and bio clear is, is kind of like that. It's interesting. And Dr.

[00:08:46] [SPEAKER_00] Marco Maialino, who I actually did get a chance to podcast with, it talked a lot about that as well. You know, how implants have kind of become the easy way out, the predictable way out. And dentists are kind of, have, have sort of gotten away from, from saving teeth, knowing how quote unquote easy implants are. But, but the, what I learned in what I find interesting from this meeting is that

[00:09:16] [SPEAKER_00] they're okay. So I remember particularly on dental town, but even then, you know, where, where we talk about herodontics, you know, like this is a really heroic save on this tooth. And, and I think there was always sort of implicit in calling something herodontics was that, well, we shouldn't even bother doing this. This is, we're, we're, we're going to great lengths for no good reason. And, and, and, and knowing that we have implants to fall back on or

[00:09:42] [SPEAKER_00] what have you, that we should just do that. And, and what's interesting is that these guys were saying, you know what, I'm going to go to great lengths to save this natural tooth. And, and they were saying that not only were they not ashamed of that, because on some level, I think herodontics, the way, the way I thought about it was like, oh, you know, if you were a good dentist, you wouldn't do this bullshit herodontics treatment. You would just, you just do the ideal thing, which was clearly an implant or something. Well, I got to tell you that the paradigm shifted pretty

[00:10:11] [SPEAKER_00] seriously for me when I was listening to these guys, because they're like, wait a second, no, no, no. You should save this tooth. You should go to great lengths to save this tooth. And Marco, who I'll have an episode out with him in the next couple of weeks, was talking about the concept of informed consent and how, how we've got it wrong. It was, it's, it's fascinating. But also both of these guys were able to show. You already know Crazy Dental has practically unbeatable prices on everyday dental supplies.

[00:10:37] [SPEAKER_00] But how do we make that deal even sweeter? Free shipping. Jump over to crazydentalprices.com, fill your cart and enter promo code veryship, all one word at checkout. That's veryship, all one word to wipe out shipping costs on every single order. Even better, using that code directly supports the Very Dental Podcast Network. Stock up, pocket the savings, get free delivery and help back the show. Use veryship, all one word today. A ton of cases that were successful

[00:11:07] [SPEAKER_00] and, and in some cases downright thriving. My thing is that a lot of us, a lot of people, I have to tell you, I have a lot of background in herodontics because I have sort of shamefully been attempting to hold onto teeth in people because I, in, in most cases it's not, it's not because it would be a better option to do, to do implants with these people or not. It's that they would never do implants, whether they were not someone who would be a good candidate for it because of health

[00:11:35] [SPEAKER_00] reasons, or there was no way financially they were going to go through, or they just would. I mean, to be perfectly frank, where I, where I live and where I work, a missing tooth in many cases is not really a deal breaker. People like, yeah, so I had a missing tooth. What's the big deal? So, so like on some level, it's, it's an interesting quandary because I think for some people, they're like the obvious move is the, you know, paying, you know, thousands of dollars for an implant and restored implant. And that's that. There's a lot of people that would prefer to not

[00:12:04] [SPEAKER_00] spend a thousand, thousands of dollars on something and, and just go without a tooth. But on the other hand, if you've got some ideas about how you might be able to save this tooth, even, even though it's heroic, they might be willing to give it a try depending on what it would cost. So it does show me that there's a lot of different ways to practice dentistry out there. There's a lot of different philosophies about how we should do. And I feel like sometimes the way heroics is portrayed is

[00:12:30] [SPEAKER_00] that heroic, heredontics is portrayed is that it's, it's just bad dentistry and it's not, and I'm going to tell you that the cases that I was seeing this weekend were not bad dentistry. They were amazing dentistry and they were, they were well thought out dentistry and, uh, well engineered dentistry. There's God, if there's one word you can use about talk about bio clear, it's engineered because there's been a lot of thought about, about this stuff. In any case,

[00:12:55] [SPEAKER_00] um, I feel better about the idea of heredontics and frankly, um, bio clear. It's so funny because bio clear has like this, this, this dual perception amongst, I guess, dentists and maybe patients, but definitely amongst dentists you've got on one end. It's, it's, it's beautiful. Aesthetic cosmetic teeth in the anterior and, and, uh, and, you know, potentially big overlays,

[00:13:24] [SPEAKER_00] composite overlays in lieu of crowns. It's, it's like minimally invasive. It's a lot of additive dentistry. It's all, but a lot of it is sort of like, this is a cosmetic way to make beautiful, you know, white, straight teeth. We love it. And then, and then when it comes to posterior, there's a ton of it that it's, it's minimally invasive and it's, we'll go to great lengths to save teeth. It's wild. Cause it's kind of two ends of a spectrum thought process wise, except it's not really, it's, it's all kind of the same. The other, the story is like, why would we do this big veneer

[00:13:50] [SPEAKER_00] case, which cuts down teeth and when we can just do an additive solution that that's really beautiful. I like that. I thought that was pretty good. Um, so for the one part I walked away, I'm like the heredonics is not, there's nothing to, nothing to scoff at with the heredonics. It's actually, if you have a skillset where you can do this, you're doing a great service for patients. And frankly, most patients would rather try and keep their natural teeth, even if they haven't done a great job with their teeth, the risk of losing a tooth for some people is a pretty big deal.

[00:14:20] [SPEAKER_00] And if you have some options and you have a skillset where you know how to do this, that's valuable. That's valuable. And patients, patients really would benefit from that. And so the mindset that that's fine, just go to implants is fine, I guess, for some people, but, but if you aren't trained in a way that you could make a save like this and implants are your only option, then shame on you, right? Like if you don't have the skillset to know how to save teeth

[00:14:45] [SPEAKER_00] and be able to offer that as an option, that's a problem. I think I, I, in the other thing about this is when you're doing, this goes back to my friend Bart's line, are you going to be mad at me if, and then fill in the blank, you can do kind of radical informed consent where the patient can choose the wild and crazy heroic thing. You can do that. In the reality, it's like on some level,

[00:15:13] [SPEAKER_00] you can tell them that, you know, this might not work. And that's, that doesn't mean you're a bad dentist. That just means that you've done the best you can with a lousy situation, but it might be worth trying to save this tooth, even though it might not work. And in some cases it might be, not only it might not work, it probably won't work, but you know what, if you got another three, five, eight years with this tooth, wouldn't that be a benefit to you? And I mean, pretty good

[00:15:40] [SPEAKER_00] argument as far as I'm concerned. I guess it depends on how much money you'd be putting into it. But, but the reality is the patient really, I think the patient deserves that option. If you, if, you know, if, if they're looking at losing a tooth, I have the classic thing. Um, Raphael's case cases were all basically like, look, it's, it's either this or we lose the tooth. What do you think? And Raph said, he's like, man, I, I restore a lot of implants. I do that. That's, that's much easier. This is a lot harder to do, but there's a lot of patients that are pretty attached

[00:16:09] [SPEAKER_00] to these teeth and, or, or implants aren't going to be a good option for him. Where if I can go to great lengths to do this? I mean, his point was, you know, it's a lot more fun to just scan in and have the lab, make you a beautiful implant crown and screw that in. It's a lot more fun and it's probably more profitable, but, but the reality is there's a lot of patients that are, you know, that's not an option for, or they're, they're pretty attached to having their own teeth. And Raph's cases, it was just one after the other he'd show. And, you know, he was literally

[00:16:39] [SPEAKER_00] like, it was literally causing everyone pain. You're like, Oh my gosh, what would I do in this situation? And he was just coming up with these, just pulling the rabbit out of the hat over and over again. And his point was all of the concepts that you learn in the bio clear courses, the bio clear method, they all work and they work even in these radical situations. They all work. If you, if you know what you're doing and you follow that, he, his point was, it isn't that I'm a miracle

[00:17:04] [SPEAKER_00] worker. It's that I, I can read a recipe because that's, because the bio clear bio clear is nothing, if not a recipe, it's an engineered recipe and it works in many, many cases. Obviously their skillset is with the practice between, you know, the people that were showing these cases, they're amazing clinicians, but they're also following, they're following the instructions that they gave us in the courses. They're like, they're not, they're not varying. And it's, this is, this is what they do. It's sort of a cookbook. So that was really cool. It was really cool.

[00:17:32] [SPEAKER_00] But if you haven't developed a skillset in how to, you know, how to save teeth and your fallback is that then I think you need to take a look at that. Like if, if, if you're only, you know, if, if you have someone coming in with a, with a chip front tooth and your only option is we're going to put a crown on this when a class four composite is much more conservative and probably will serve the patient for better. Even if down the road, it might need a crown because it's lost enough tooth

[00:17:57] [SPEAKER_00] structure. It, I think the patient deserves the option. I really do. And the reality is, is as, as Marco is saying, informed consent is a weird thing because we think that everything is cut and dried and that we're offering this patient. These are the options. And this is what, this is what, you know, I would recommend or not recommend, but all informed consent is based on what the dentist is comfortable doing treatment wise. So, so for someone like me that doesn't place implants,

[00:18:25] [SPEAKER_00] doesn't love surgery. Well, yeah, I'm probably going to be going closer to the heroic save of the tooth because I'm much more comfortable in that realm. I have my, I have a much better skills set for saving teeth, you know, and it's not that I couldn't learn or place implants, but I don't. I, so maybe I'm the guy who tends to move away from implants, but, but if you're an implant guy and you really don't have a skillset in, in saving badly damaged teeth or giving that option, well, then your informed consent looks a lot different. And so there's an argument to be made that

[00:18:53] [SPEAKER_00] really and truly informed consent is a bit of a flawed concept because a dentist can only give it from the viewpoint of their own clinical skillset. It's very interesting. So on some level, am I telling you, you don't need to learn implants. You need to learn to save teeth. No, I think, I think implants have a ton of great places for them. But I also think that

[00:19:17] [SPEAKER_00] I think when the pendulum is swings far enough away where, you know, regular run-of-the-mill dentists don't have a really good skillset on saving, you know, a more badly damaged tooth, I think we need to take a look at that. And frankly, if you're interested in learning more about that, you could do no better than going out to Tacoma and having those guys teach you how to, how to use the bio clear method. I, there is not just composites. It's really, the whole method is just really,

[00:19:45] [SPEAKER_00] really interesting and really good. I had such a great time out there. They got a lot of really good people there. And they're, you know, a lot of, it's not just matrices. As I said in the podcast, it's not just matrices. It's not just heated composite. It's the people, it's a community and a lot of supportive people and who are pretty passionate about doing as, as close to minimally invasive dentistry as possible. And I do think frankly, that that is, that's something worth trying to do. It really is. So, uh, I hope that, I hope that that is something you'd be interested in. Now,

[00:20:15] [SPEAKER_00] if you have questions about bio clearing like that, I'd love you to ask me about them. And many other people who know a lot about it, one of them being Dr. Artie Volker, who's perfectly active in the, in the very dental Facebook group. If you're not a member yet, you should go to Facebook and you should look up very dental. And I'm going to ask you for a password and there's lots of passwords, but why don't, I'm just going to give you the password bio clear. Cause it's been a password there for a while. Just give me the password bio clear. We'll get you into the group and you can ask any questions you might have or have a conversation.

[00:20:42] [SPEAKER_00] You can tell me that I'm a cry baby for, for complaining about people not wanting to hear reruns, whatever. I'd love to hear about it. Um, and I, I, I hope you enjoy the show. I wish you'd tell a friend about it. I'm, I am, it helps to go to a meeting and get some interviews and talk to some great people and have some good content for you. I'm very excited about what we've got coming up. And honestly, I'm pretty excited about what we've had, had some interesting stuff in the last couple of months. So, um, if you'll like the podcast, if you're getting something out of it,

[00:21:09] [SPEAKER_00] go to your, whatever podcast player you have and give me a rating. And more than that, tell a friend, tell, tell, tell one of your dental friends, like, Hey, you probably liked this and, and show them how to do it. Cause I'm, I don't do a lot of video. I'm, I'm thinking about moving into a more video centric place, or at least adding some video aspects, but I've been an audio podcaster for 12 plus years in audio podcasting. I do think it's sort of fading because I don't know if we're getting older or

[00:21:37] [SPEAKER_00] younger folks are just not that interested. Tell them about it. I want to, if, if maybe they're only going to listen to one podcast and I'd love it if this was the podcast they listened to. Thanks a lot for listening to you guys. I appreciate it. And I'll catch you next episode.