Very Clinical: Getting Ahead of It, part 1: Anesthesia and Occlusion

[00:00:01] [SPEAKER_00] This is a production of the Very Dental Podcast Network. Welcome to the Very Clinical Podcast. In about the time it takes to do an MO on 3, we will entertain and amaze you with tips and tricks on regular daily dentistry. Here's Kevin and Zach.

[00:00:28] [SPEAKER_01] What is up, Very Clinical listeners? Welcome back to yet another episode of the podcast. I am Zach Miners coming to you from Kansas City, Missouri. With me as always, my trusty co-host, Dr. Kevin Hare Fryer. Kevin, is Cleveland ready for the baseball playoffs?

[00:00:43] [SPEAKER_02] Well, we're ready for the playoffs. The Browns are in first place.

[00:00:48] [SPEAKER_01] Yeah, what's up with that? How?

[00:00:50] [SPEAKER_02] And three, my dog pooped all over our brand new rug today. So everything's great here.

[00:00:55] [SPEAKER_00] Wow. Everything's coming up, Kevin. Those things are absolutely not correlated. Just a list of things. It has nothing to do with... Yes.

[00:01:03] [SPEAKER_01] The third voice you hear, we brought on an expensive guest. If you've, you know, if you're a subscriber to this podcast feed, you might have run into one of his shows, Dr. Alan Mead.

[00:01:15] [SPEAKER_00] Perhaps. Perhaps. Well, thank you for having me. Thank you for having me on this... On your own feed. Yeah. This podcast. You've been had.

[00:01:24] [SPEAKER_01] Yeah, you have been had. I have been had. So, hey, it's a sad day, guys. I don't know if you know about this. But if I say, hey, hey, hey, what is going on here? Does that ring any bells as the Mr. Belding chant to his Bayside students? Well, bells...

[00:01:47] [SPEAKER_00] He always kind of came in saying that. That's right. Yeah, he did. Because they were getting into mischief. That's the whole thing. Anyway, he checked out today.

[00:01:55] [SPEAKER_01] Oh! That's a bummer.

[00:01:56] [SPEAKER_00] Oh, I didn't realize. Okay, so Mr. Belding...

[00:01:58] He died.

[00:01:58] [SPEAKER_01] That was the whole point, Alan. He died today.

[00:02:00] [SPEAKER_00] Cooked the dirt in half. I missed it. Okay, I missed that. Yeah, that's it. It's over for him. Okay. I'm sorry.

[00:02:04] [SPEAKER_01] No, it's okay. I've accepted the loss.

[00:02:07] [SPEAKER_00] You know that Saved by the Bell started out as a different show, you know that? Like the early Saved by the Bell. Yes, Good Morning Miss Bliss. Yeah, Miss Bliss. Exactly. It was like a totally different show and it like, it transformed once they found...

[00:02:17] [SPEAKER_01] What was the main actor? The Miss Bliss was a major feature actor. Yeah. What's her name? Robin Williams. It was not Robin Williams. I think she's alive. It was Meryl. It was Meryl Streep. No, um... Gosh, now I'm gonna look this up here while we're... Hayley Mills. Hayley Mills. Oh, Hayley Mills. So Hayley Mills is like from Miss Bliss.

[00:02:45] [SPEAKER_01] And then that concept like died immediately and then they took the kids and were like, okay, well, we'll do the high school thing. It was funny because Miss Bliss was set in like Illinois and then all of a sudden they're in California when they switched it to Saved by the Bell.

[00:02:57] [SPEAKER_00] Some of the same kids and they were in... Yes. Okay, so it looks like the series started in 1987, so I was still in high school when it started.

[00:03:03] [SPEAKER_02] Was it more serious with Miss Bliss and then it kind of... Yeah. Wacky?

[00:03:08] [SPEAKER_01] Uh, you know, if it was written today, Miss Bliss would kind of be the teacher that all the kids wanted to get with, you know? Oh! Oh! There's a lot of that going on. Yeah. Or... Or... It was a different time. It was a different time. For sure. But no, I like that guy. I like Dennis Haskins. He wasn't in much else. That... He was so typecast from that role it destroyed him.

[00:03:30] [SPEAKER_00] So... I think he did... I think he hosted like... Years later, he hosted some kind of an award show or something. Like maybe on an MTV. Yeah. I don't remember. It sounds like that. Yeah.

[00:03:39] [SPEAKER_01] Anyway, he was a good actor and like I said, I... My sisters and I watched the crap out of Saved by the Bell in syndication on TBS and TNT after school. After school, yeah. So... Mr. Belding was a big part of my after school experience. Yeah. So... Anyway, RIP Mr. Belding.

[00:03:56] [SPEAKER_00] At the University of Minnesota, we had a gigantic television in the... at the Psi Omega house. Second floor. And it was... It was a projection TV. And I will say that Saved by the Bell was likely on in syndication on occasion on the giant TV at the Psi O'House. Yeah. Yeah.

[00:04:13] [SPEAKER_01] Good stuff. Not for you, Kevin. You're... Sorry, Kevin. You're too old. I was in middle school.

[00:04:17] [SPEAKER_02] I knew of it and I probably did watch it, but not... It wasn't like... It would have been on after Pee Wee. Like probably like... Yeah. It was like the 11 o'clock show. Yeah. So... Yeah. Yeah. For sure.

[00:04:32] [SPEAKER_01] That was like the show aimed towards... You know, Pee Wee was aimed towards like your... I mean, it ended up being cool for adults too, but it was aimed towards your like 10 to 11 year old team. Yeah.

[00:04:41] [SPEAKER_02] If I had worked well for me in dental school.

[00:04:43] [SPEAKER_01] Yeah. Amen, brother. Okay. We're starting a new series, limited series tonight. Limited edition. What are we calling it? Alan, what are we titling this series?

[00:04:53] [SPEAKER_00] Getting Ahead of It. Getting Ahead of It.

[00:04:56] [SPEAKER_01] Getting Ahead of It. Yeah.

[00:04:56] [SPEAKER_00] Getting Ahead of It, which sounds actually sexier than I actually meant it to, but getting ahead of it. Yeah. Yep. You can take that the wrong way.

[00:05:02] [SPEAKER_01] So we're going to be talking about some of the things that we say or do for patient interactions on procedures to avoid questions, complaints, general... You know... Malaise. Malaise. Malaise.

[00:05:45] [SPEAKER_01] Malaise.

[00:06:15] [SPEAKER_01] Avoid callbacks and complaints and all that other stuff. Anyway, we're going to start with something that's, of course, that's maybe universal to every procedure. And we were going to talk about just anesthetic, anesthetic delivery. And I will let Alan kick it off with what is something you say to patients that you know they're going to say something about if you don't anticipate it in advance?

[00:06:43] [SPEAKER_00] That's really interesting. Okay. So I'll start by saying, if you're someone who has used topical anesthetic and you forget it, they'll never let you live that down if you've used it on them before. So a lot of times... I will say I do use topical most of the time. I don't probably let topical sit as long as it is supposed to.

[00:07:06] [SPEAKER_00] So a lot of times I will not say that the topical is going to make it so it's painless. It will take the sting out of it a little bit, something like that. We use topical a lot, but I also, I'm too impatient to let it, except in the interior, I'm too impatient to let it sit. So that's the first thing I'll tell them about that. So anesthesia. Interesting.

[00:07:25] [SPEAKER_01] Where do you want me to go?

[00:07:27] [SPEAKER_00] I don't want to steal your thunder because you had a really good one versus top versus bottom anesthesia. You should start with that.

[00:07:33] [SPEAKER_01] I'll start then. I'll tell you what. So one of the things, if I don't know if you've, if you've ever worked on, I'm sure almost everyone has, if you've ever worked on like, you know, a couple fillings on 12 and 13 and then a couple on 18 and 19. Yes.

[00:07:45] [SPEAKER_00] Yes.

[00:07:46] [SPEAKER_01] Consistently, the, the quadrant that is blocked is always going to feel or be perceived as more numb. Um, I mean, I know everyone has their own technique. I'm sure someone who's, who says they use some total numbness or whatever may, may say something different. But if you're a, if you're a basic dentist and you give a lower block and then you, you give an upper, like, you know, PSA or infiltration. Basic bitch. Basic bitch. Um, they're going to say, man, the lower sure feels numb, but I don't feel like you did anything to the top.

[00:08:15] [SPEAKER_01] And so it's like, I always say. I heard that as recently as today. Yeah. I, yes. And so I, I've gotten more on the bottom.

[00:08:22] [SPEAKER_02] Yes. Not on the top.

[00:08:23] [SPEAKER_01] That's correct. I've always say you're going to feel more numb on the lower. You're going to, you're going to be the same amount of numb on the top, but it's just not going to feel the same. So that's, that's something that I've always done just to avoid that because it is every single time. Yep. Every single time, no matter whether you're taking out some wisdom teeth or whatever you're doing, it's always more numb on the lower.

[00:08:42] [SPEAKER_00] On patients you've seen many, many times, you can explain the same kind of thing too. Cause I think, I think sometimes a patient who's used to being numbed up on the, on the lower, when it isn't that outwardly numb on the top, they're kind of freaked out. Like, Oh, you sure? Are you sure it's dumb enough? Yeah. Are you sure it's not enough? I think that's really, that's really something. So I explain that often. And, and I think that's a really valuable thing. Um, and have you, have you guys been numb before? Yeah. The lower is, is wildly more numb feeling than the top.

[00:09:12] [SPEAKER_00] You could, you could kind of, you could kind of miss it on the top compared to that, especially since the half time you get their lip and tongue and all that stuff. So I totally agree with that.

[00:09:20] [SPEAKER_01] Um, yeah. I mean, and, and, you know, the, you mentioned patients that you've seen multiple times, even on someone that you've done the, done it on before, you have to remember that they like have the interaction and then forget about it. Yeah. You know, whereas, you know, you were doing it so we don't, you have to say the same thing every single time. It feels like almost every single time, you know, you have to repeat it, even if it's only been, you know, a year or so since you've done something like that for them. Um, here's, uh, here's another one I have.

[00:09:49] [SPEAKER_01] I assume you guys, when you guys give it a palatable shot, do you kind of alert them? Hey, you know, when you numb this, when we numb this side, there's going to be more of a pressure feeling from the tight tissue and liquid distribution. So I use something like that.

[00:10:03] [SPEAKER_00] I use a, I use a pair of jack or a pencil or a PDL. I use that a lot. I use that multiple times a day and, and I will, what's really funny is if you've, if you, uh, I'll, I'll do it for tissue around. Like if I'm, I took a, I took 19 out today. I did a block. I did a, uh, I half a carper, carper sit nest, carper lidocaine, and then a carp of a half a carp of marcaine for lane.

[00:10:28] [SPEAKER_00] And then I took the, the PDL syringe and I just do, I'm not even in the PDL, just the tissue around it. I always warn them. You might feel a little bit of a pinch. Well, you know, if you blocked them, a lot of times they don't feel a pinch at all. Right. But I'm going to tell you that the value in that is if you warn them and they don't feel a pinch, they think you're amazing. Sure. But if you, if you don't warn them and you go right in for the palatal and they're not ready for it or whatever, like, whoa. And I, so I always, if I'm doing the pal that on the palatal, I always take a mirror handle and lean into their palate like crazy.

[00:10:56] [SPEAKER_00] So you're going to feel a big bunch of pressure and you might feel a pinch. And half the time, if you lean on it hard enough with the mirror handle, they don't feel anything, but it's always with, with that pressure syringe. I always tell them they're going to feel it. They're going to feel a lot. And then they, they buck up if they don't feel it. So it's, but as I always warn them just cause you never, some people feel everything and some people don't. I'm blown away by how, how many people don't feel the palatal. Uh, but cause that, you're doing, you're doing something right, Alan.

[00:11:22] [SPEAKER_01] That's, that's a testament to you.

[00:11:23] [SPEAKER_00] Well, I don't, I don't, or maybe some patients are just tough too.

[00:11:28] [SPEAKER_01] Some, well, there's no question that pain tolerance, which brings me into my next one. You know, um, so one of the things I've always said about anesthetic, I'll, and I, especially if I'm, if I'm working on something that I haven't, I haven't worked on before. I'll say some of the effect of, you know, uh, anesthetic is similar to medicine. There's a different dose for, for different people. Yeah. Um, I'm going to give you kind of a standard dose. And if that doesn't, if that doesn't get us where we need to be, we'll add more.

[00:11:58] [SPEAKER_01] I don't know how much, you know, especially if I haven't worked on it, I don't know how much it takes to get you numb. Yeah. Uh, because that avoids the, I've gotten the, like, uh, if I, let's just say I miss a block. I mean, then sometimes it's a miss type of thing. I always hate the, like, well, I've never had to have more anesthetic added to my life. I hate that. But if I preempted it with something like that, then it seems to be accepted. That's just something I say. I don't know. Do you guys do anything similar to that?

[00:12:23] [SPEAKER_00] I'm so heavy handed with anesthetic that like. You just overload. Okay. I just, I just do. I give a lot of anesthetic. I, and I mean, to a fault, maybe I think there's some patients that'll come, oh my gosh, I've never been so numb and stuff, but I'm like, it really beats the alternative. I feel like. So I'm, I'm pretty heavy handed. Um, I, and I always, the thing about blocks that I always tell them is everyone's built a little bit differently. So, and, and I, I feel like I can tell. That's a good line.

[00:12:53] [SPEAKER_01] Everyone's built a little different.

[00:12:54] [SPEAKER_00] Yeah. Well, cause the other thing is sometimes, I mean, when you're given a block, a lot of times, if you go for your typical place in anatomically, it's a lot of times it's where I, where I find the bone with the needle, you know, but nothing worse than when I think I'm right where I'm supposed to be. And I just go and it just goes and goes, you don't touch bone at all. So when that happens, I know I'm going to need a couple, a couple tries to get it right. And I'll just tell them sometimes people are built a little differently. Your anatomy is a little tougher. I'm going to find it, but it's going to be a second.

[00:13:19] [SPEAKER_00] So I, I almost do that to, to warn them that I'm going to need to do a second block just to make sure I get it. That, and I, patients seem to be okay with that there because it's true.

[00:13:29] [SPEAKER_01] I know you've never missed a block. Um, but, uh, must be nice, but have you ever gotten like that complaint of like, Oh man, like, you know, I've never had this happen where I, you know, got a, got a shot and didn't get numb. You know, you ever heard that one or do you have a response or a preempt to that?

[00:13:48] [SPEAKER_02] I mean, I, I've heard it. Um, I just, I don't know. I think I just kind of dismissed all that. I, yeah, I, I think listening to this, I'm more about a get behind it guy than get ahead of it.

[00:14:02] [SPEAKER_01] So, um, uh, this topic isn't for you then maybe you try listening to a different show, you know, try one of our different episodes.

[00:14:09] [SPEAKER_02] But like, for instance, on the upper anesthesia versus the lower anesthesia, a lot of times, you know, patients will say that doesn't feel very numb. And I'll just say, I assure you it is. Cause it is. It just is.

[00:14:24] [SPEAKER_00] Yeah.

[00:14:24] [SPEAKER_02] You know? And then if they say, well, I think I need a little bit more. I'm like, okay, fine. I'll give you some more, but I know it's numb.

[00:14:30] [SPEAKER_00] I got, when they're, when they're like that, I'll tell them, I'll tell them too. I say, look, I think you're probably there, but don't you worry if you're feeling a thing. I've got more. They never want more if they're really numb. I mean, they're not, no one's just looking for more necessarily. You're right. I mean, it's, I will say this. Do you ever have the thing? Occasionally I'll miss on an upper infiltration where they're, they're just not getting numb enough. And 99% of the time you realize the vestibule goes up higher than you, than you realize.

[00:15:00] [SPEAKER_00] So you just didn't get the needle up there very far. And basically if you can anatomically get it past wherever you're bumping into, you're like, oh, that's where it needed to be. So they were like literally almost not numb from it. Um, I hate that by the way. Then I, I use the same excuse. People are built differently and I just got to get it to the right place. But yeah, that's, anesthesia is a funny thing that way. Cause I think people, people are so, uh, and it depends on what kind of experiences they've had with other dentists, you know, like, it does depend on, I think also it is dependent

[00:15:27] [SPEAKER_02] on their nervousness level, particularly for the upper. Yes. You know, from doing Sarek crowns, you know, it takes like an hour and a half hour, 45 minutes. I'm amazed at the people that aren't, aren't still numb by the time we seat the crown. Yep. Um, I I'm occasionally it'll happen. Like we always do a try, um, try and right out of the mill. They're not numb there. Uh, that's the way end of the bell shaped curve. Like what is happening inside here that is blowing all that off.

[00:15:57] [SPEAKER_00] And yeah, certainly I feel like anxiety, anxiety will burn anesthetically crazy. I'm not sure exactly why that is.

[00:16:04] [SPEAKER_01] I would imagine if you had a heart rate tracker on them and they'd be, well, on the sedated

[00:16:10] [SPEAKER_02] patients we do have, you know, we have everything and you can see, you know, their, their heart rate rise obviously with the epinephrine, which that there's another thing we need to talk about the, the people who are air quotes allergic to epinephrine. Um, I've started like, so, uh, I had a procedure done. Uh, well I had my implant on my, uh, front tooth and you know, my oral surgeon made me numb.

[00:16:39] [SPEAKER_02] Um, I'm hooked up to a monitor. I don't remember why, but my heart rate went, Oh wow. Like I felt like the jitters, you know, like, and, um, but I'm, my big brain is saying, well, that's normal. Yeah. I know what just happened. I'm, I'm not like nervous, nervous. I'm like low level.

[00:17:01] [SPEAKER_00] Um, you know, I'm going to have, yeah, but like your body doesn't know that your brain knows better when you get a big dose of epinephrine. That's your body's wrecked in the same way. That's right.

[00:17:09] [SPEAKER_02] I could talk my way through it. You know, I felt like I had, uh, some espresso or something, you know? Yeah. Yeah. Um, so when I started asking patients or cause I hate using carbacane on these people, they're going to bleed like crazy and it's not going to last.

[00:17:28] [SPEAKER_01] Right. Or if it even works at all. Yeah.

[00:17:30] [SPEAKER_02] Right. So I'll look them in the eye and say, did your heart beat really fast when that happened? Cause that's kind of normal. Like that happens to like, I'll use the bandwagon technique that happens to a lot of people. I know that's uncomfortable, but you know, it's more uncomfortable. Well, have me having to re-inject you every 10 minutes. Give you shots all the time.

[00:17:49] [SPEAKER_00] Like a lot more shots. Exactly. Exactly. So that's a smart one. That's for sure.

[00:17:53] [SPEAKER_02] That works like half the time. It doesn't work on everyone. And it's, I'm sorry for our female listeners of which there are probably two. Um, it's 90% females.

[00:18:06] [SPEAKER_01] It is. You're right.

[00:18:07] [SPEAKER_02] When this happens. And I just wonder.

[00:18:09] [SPEAKER_01] I can't think of a man that's told me that.

[00:18:11] [SPEAKER_02] A hundred percent. I can't think of one either. No. And I just wonder, you know, I've, I can't say this cause it's super sexist, but.

[00:18:21] [SPEAKER_01] You mean we haven't already gone there? I feel like we've already, we've already broken that.

[00:18:25] [SPEAKER_02] You know, like, uh, there are both men.

[00:18:31] [SPEAKER_01] I don't think either, either a woman that's listening is going to be offended by what you're already saying. That's right.

[00:18:35] [SPEAKER_02] What sort of excitement do you have in your life where your heart rate gets up like that?

[00:18:40] [SPEAKER_01] Yeah.

[00:18:40] [SPEAKER_02] You know, like. That's a good question. I love that unanswered. I enjoy that.

[00:18:46] Yeah.

[00:18:47] [SPEAKER_02] Like that happens to me when I'm playing pickleball.

[00:18:50] [SPEAKER_00] Yeah.

[00:18:51] [SPEAKER_02] You know, like, whoa, you're into it or whatever, you know?

[00:18:53] [SPEAKER_00] Sure. Do you ever, do you ever get ahead of the red heads? Uh, yeah. A new patient that comes in, in their red head. You're like, okay, let's have this talk right now. Cause it's it, whatever, whatever they say about red heads and anesthesia. It's true. It's true. I don't care. It's true.

[00:19:09] [SPEAKER_01] I'm a lot of them. Thankfully seem like they already know. They know. Yeah. A lot of them know. Um, and I will kind of joke with them like, like, uh, you know about red heads and an aesthetic, right? And if they say, oh yeah, I know then we don't have to have that talk. But if they, they, if they shrug or like, what are you talking about?

[00:19:27] [SPEAKER_02] Or, you know, I'll confess that I was a non-believer till about five years ago. I had a really poor outcome on a, uh, extraction graft procedure on a red head. And she, like, I was, I, you know, was on the phone with her all. I was like, walked her through, it was like two or three weeks of poor healing. And, you know, she said, well, I'm a red head. And I like, just went with it, you know? Yeah. Oh yeah, you are. You know, that explains it.

[00:19:57] [SPEAKER_02] In the back of my mind, I'm like, you know, maybe there is something to this. Yeah. Yeah. There you go.

[00:20:02] [SPEAKER_01] Do you, do you get the people that, uh, uh, complain about the, their eyelid getting their eye going? When you, when you hit there.

[00:20:13] [SPEAKER_02] Yeah.

[00:20:13] [SPEAKER_01] Okay. Yeah. Well, I, I've had too many people say like that they've never experienced that before. Basically implying that I did something wrong. You did something wrong. Yeah. Yeah. And so I've definitely got, anytime I'm, I'm numbing now, like a first primo or a canine, I'm always like, there's a pretty good chance your, you know, eyelid or something is going to.

[00:20:32] [SPEAKER_02] Sometimes that happens.

[00:20:34] [SPEAKER_01] Yeah. If you see that. But see, good for you, Kevin. I'm still in the, like, it feels accusatory. You know, it feels like they're basically implying I did something wrong. I can't take it.

[00:20:45] [SPEAKER_02] So this is, I get it.

[00:20:46] [SPEAKER_01] I don't, these are my insecurities coming out on this podcast. I hear it.

[00:20:48] [SPEAKER_00] What's weird about that is I'm a very insecure person. That generally doesn't feel too bad for me. I will say this. I always look for in that area. A lot of times you'll see that, that blanching or that, that's crazy or whatever and blanching. I always give them a mirror and say, check that out. That's wild. Isn't it? That's totally normal. And then, then they'll say, yeah, my eye feels a little funny. So if that is a, honestly, when you're doing upper premolar anesthesia, always look for that. If you could, that's a total get ahead of it because you can see it before they feel

[00:21:16] [SPEAKER_00] it when that thing goes in their upper prem. Yeah. It's so, yeah, that's one to, that's one probably to remember. And, and I'll tell you what, the first time that happened to me, I thought I had done something wrong. Sure. Same. And this was, it was early enough that I didn't have some, you know, group chat to go to, to say, what the hell is this? So yeah.

[00:21:33] [SPEAKER_01] I can remember one of the first times that happened to me, I was working on my, one of my cousins and they, they like, like I said, they immediately were like, Oh, some, you know, noob that sucks. Yeah. Yeah. I'll switch gears to, I got, I got one more though. I got one more.

[00:21:45] [SPEAKER_00] This is, this is too good. Please go ahead. So the story is when, okay, nine times out of 10, when they have post-op discomfort from, I mean, that's, you can have post-op discomfort, but man, you know what? Shots give more post-op discomfort than a lot of anything.

[00:22:03] [SPEAKER_02] I gave you a shot in your mouth. It hurts.

[00:22:05] [SPEAKER_00] Yeah. And, and you think about how tight that tissue is. And I put a bunch of liquid in there. Yeah. It hurts like crazy. Yeah. And the reality is it's going to hurt more where I gave you the shot probably than the tooth does. Just understand that that's normal.

[00:22:16] [SPEAKER_02] I think to Zach's point when they say, well, that never happened before. Like, well, you know, like what I don't think you can really ever convey to people is that you've done this a hundred thousand times and have, have had every single outcome possible. Yep. And sometimes that happens. Yeah.

[00:22:35] [SPEAKER_00] And they've experienced, they've experienced very few. Right. That's the, you know, it's the difference. I don't have a good answer.

[00:22:41] [SPEAKER_01] I just said that, that I, I, all of these are born from me being so sick of that's never happened to me before. And so I do anything I can to not hear that statement. I've just, it's a personal problem.

[00:22:55] [SPEAKER_02] Can I, can I talk about the occlusion thing at the end though? Do you? Yes. So, all right. So you just seated your crown or did your filling or whatever, and you check occlusion and the patient's numb. Mm-hmm. And it took me like 20 years to get ahead of this one, maybe 25. Um, because typically you'll have, you know, have them bite on their articulating paper or whatever. And then you'll say, does that feel okay or whatever? And they'll say, I don't know.

[00:23:24] [SPEAKER_02] I'm numb.

[00:23:25] [SPEAKER_01] Yep.

[00:23:26] [SPEAKER_02] Right. Yeah. So what I've started saying, like, let's say we're working on the number three. I will say, I know you're numb over here and touch them where they can't feel it, but they can feel the pressure. Right. I'm not numb over here. Bite together. Does that side feel normal? Like I'm, I'm getting ahead. Cause I hate that. Um, I don't know. I'm numb. Well, you can still feel the other part of your mouth where you aren't numb.

[00:23:53] [SPEAKER_01] You know, I'm interested. So no, no, you're correct. I do. You know what? I just thought about, I do say that I want to check your bite or when I, when I go to ask them when I've, after I've already done my bite check and I feel about it. I say, Hey, listen, I already know you're numb on this side. You can, if you can give me any feedback in terms of if you're non numb side feels like it's touching or anything, any, any kind of, give me, I'll take it, you know,

[00:24:17] [SPEAKER_02] I touch them on the other side. Yes.

[00:24:19] [SPEAKER_00] That's, that's, that's smart. That's a good technique.

[00:24:21] [SPEAKER_02] Is this side normal?

[00:24:22] [SPEAKER_00] Does the side that's not numb feel like it's touching normally? I'll do that. Yeah. Yeah. The other thing that I do is I am for my bite, for my bite checks, particularly on crown, crown seats, but also honestly, like if I'm doing a quadrant of fillings or whatever, I like to check with, with shim stock, uh, before I ever get bite paper in there. Cause the shim stock tells me where they're touching and where they're not. I mean, where they're holding. And then I can go, I know if they are holding or not. And then it tells me where, but the other thing is when I know, particularly like a crown seat, when I know that it's, it's fine, they're holding shim on both sides.

[00:24:53] [SPEAKER_00] I'll say, listen, I can't trust your judgment right now. You're numb. And, uh, and if you come out of the numb, I said, I am certain that we got this right. But occasionally patient comes out of the numb. It feels a little bit funny. If you come out of the numb, don't worry. We can, we can fix this. It's a lot easier to fix when you're not numb, but I'm pretty sure we got it. And what that does is that generally gets them out of the idea that they can actually feel what the hell's going on. And they're telling me that, Oh, or that you did something wrong. Exactly.

[00:25:20] [SPEAKER_02] But the other thing that I do is what, when I'm getting this, I don't know feedback because I've lost all proprioception of my entire body because I've made one bicuspid numb and you can't feel anything. Uh, I'll say, well, it's really important that we get your bite right. Cause otherwise you'll end up with a toothache. Yeah. Oh yeah. Uh, oh no, it does feel a little high. Okay, great. Let me, let me take care of that now.

[00:25:47] [SPEAKER_01] I've definitely had some people though. Also the, because I, because I feel like the numb side feels a little thicker. They will. I feel like I'm having to talk them out of me just blasting the tooth.

[00:25:59] [SPEAKER_02] Yeah. Way out of occlusion. That happened today to me. I knew I had it a hundred percent. Right. I, you know, sometimes you just go.

[00:26:06] [SPEAKER_01] Yes, I know.

[00:26:07] [SPEAKER_02] And I walked up front and I saw the guy biting his cheek. Stop it. I, and then, then the front desk is like, uh, Tom thinks his crown is high. And I'm like, he just, I saw it. Bring him back. I'll, I'll, you know,

[00:26:25] [SPEAKER_00] And the, the, the assistants already cleared the goddamn room every time.

[00:26:29] [SPEAKER_02] She was only, she was, it all worked out. And I just, he, I've known this guy forever. Like I watched you up there, bite your cheek. That's what was happening. Your bite's fine. Yeah. You're, you know, you're still numb.

[00:26:39] [SPEAKER_00] Don't bite your cheek. I do think it's funny where, when they're numb, but in there, they'll say, oh, it feels like it's hitting. Yeah. If you just seated the crown on three and they'll point at five, go, wow, it's really hitting heavy. And you're like, well, it's yeah, that's cause you're numb. They don't, I don't necessarily try and explain. I typically say, you know, I'm pretty sure we got it right. And that's after I've checked with gym stock.

[00:27:01] [SPEAKER_01] I'll tell you the other, the other thing that's worked for me in situations like that. And then this applies more to not to the single tooth case or even the, like the, the quarter, but like the, the bigger case, I just schedule them back. I would say, you know what? I'm just going to schedule you back for a bite check. Yeah. But I'll tell you what, if I got it right, you can cancel that appointment. Oh, that's really good. That's really good. And you know what? That gives them the like peace of mind of knowing that there's a problem. You're not leaving them high and dry. It's going to get solved and they're not high and dry and they're not going to have to wait weeks or something like that.

[00:27:30] [SPEAKER_01] They, you've got an appointment for like the, you know, to check this. And then, you know, nine times out of 10, they cancel. And the one time of 10, you didn't miss it and you get the chance to fix it. That's a bigger case thing now, for sure.

[00:27:44] [SPEAKER_00] Double book them. So you're not burning. Yeah. Cause you're almost expecting them to not come, which is awesome. I love that. That's that's, I've not done that before. That's really good.

[00:27:53] [SPEAKER_01] Well, just again, that's only for your larger. So that's only a once in a while thing. Unless you're, you know, you're a big case guy.

[00:27:59] [SPEAKER_02] So for the sedated patients, it's really hard. And oftentimes we're working in multiple quadrants. So I'll talk to the driver and say, I think I got everything right, but I can't really tell cause she's super numb and she's out of it. So if it's not right, I'm like directly to you, let her know that that's okay. We'll adjust it tomorrow or the next day or whatever. Um, cause it's hard.

[00:28:24] [SPEAKER_01] And it's easy to fix when you're not numb. I would think for the sedated patient, it would almost be protocol to have them.

[00:28:31] [SPEAKER_02] Yeah.

[00:28:32] [SPEAKER_01] You know, it depends on what we do. Well, yes, yes, yes, of course. Um, but I mean, just to, just to, if you were inserting something like, you know, multiple units to, I think it'd be almost impossible to get that right. I'm sure you get it right more than I think, but you know, still it's gotta be, that's gonna be a tough one.

[00:28:49] [SPEAKER_02] If it's a little, it's always going to be a little bit off.

[00:28:51] [SPEAKER_01] Yeah. Yeah. It is what it is. Well, shoot.

[00:28:55] [SPEAKER_00] We didn't leave it out of time to talk about. No, no, that's well, I think we need to do a separate episode for it. This was true.

[00:29:00] [SPEAKER_02] Maybe, maybe we could do it next week.

[00:29:03] [SPEAKER_00] Maybe. I think we should do it next week.

[00:29:05] [SPEAKER_01] Maybe. That's a great idea.

[00:29:07] [SPEAKER_02] All right. By the bell. We, Oh, that's good.

[00:29:12] [SPEAKER_01] Any, uh, Kevin, any, uh, final thoughts, double downs, corrections, apologies?

[00:29:18] [SPEAKER_02] Uh, how about the patient that says, like, they have multiple crowns already. And then like, you're going to start the procedure and like, I have to be numb for this.

[00:29:30] [SPEAKER_01] Anyway, I don't have to, I mean, that's a whole different thing. Like that drives me nuts when people that have had just lots of procedures, then act, act like they've never had the procedure.

[00:29:47] [SPEAKER_02] That's how not, it's either how non important it is to them or how whacked out they are nervous.

[00:29:54] [SPEAKER_01] Yeah. I don't know what that is, but that one's tough to get ahead of because you almost do going with, when someone's got like 10 crowns, you go in and you're doing one, you kind of go in with the assumption that they kind of.

[00:30:07] [SPEAKER_00] If I've done multiple crowns, Mike, my joke is always, God, you've done this enough times. I might just, you can take care of this. I'll just go drink coffee. Ha ha ha. Yeah. Except if they're acting like they've never done it before. You're like, what? No. What are you?

[00:30:20] [SPEAKER_01] I don't have an answer for that because those always catch me off guard. Yeah. I agree.

[00:30:24] [SPEAKER_02] Anyway, I don't have any take backs except that I wish I could turn back the clock to 4, 12 PM and arrive home at 4, 11 PM instead of 5 PM. Cause then my evening would have been better. Thanks a lot, Ringo for pooping on the rug. Yeah. You would let the dog out.

[00:30:42] [SPEAKER_00] How about you, Alan? Final thoughts? I have no take backs. Everything I said was exactly right and perfect really.

[00:30:50] [SPEAKER_01] Yeah. So you don't need a, you don't need a follow up appointment. Is that what you're saying? You do not need that.

[00:30:54] [SPEAKER_00] I do not need 5. I used Shimstock. Yep.

[00:30:56] [SPEAKER_01] Exactly. All right. Hey, thank you guys for listening and we will see you next Tuesday.

[00:31:02] [SPEAKER_00] See ya.