Very Clinical: Getting Ahead of It, part 2: Everyday Operative

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[00:01:44] [SPEAKER_01] see what your practice could be saving. 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 three,

[00:02:09] [SPEAKER_01] we will entertain and amaze you with tips and tricks on regular daily dentistry. Here's Kevin and Zach.

[00:02:16] [SPEAKER_02] What is up, Very Clinical listeners? I'm Zach Miners, coming to you from Kansas City, Missouri, and with me, as always, my trusty co-host, Dr. Kevin Hare Fryer. Kevin, how is October going in Cleveland? I have a question for you. Please. Do you prefer fall or autumn?

[00:02:35] [SPEAKER_00] A fall. Why does it have two names and the rest of the seasons only have one? What's so special?

[00:02:43] [SPEAKER_02] That's a good question. Do you have an answer? I don't. Never-ending debate. But, I mean,

[00:02:50] [SPEAKER_01] autumn has a little bit of a, like it's, I don't know. Sort of hoity-toity, really. It's kind of, it's sort of formal sounding. Yeah, fancy fall. Fancy fall. It is. I like fall, though.

[00:03:02] [SPEAKER_00] I like fall. I do like fall, but perhaps we should enjoy autumn together.

[00:03:09] [SPEAKER_02] We will. We will. We brought back, as promised, Dr. Alan Mead. Alan, welcome back. How's your fall going up there in Michigan? Or autumn? How's your autumn? Is your autumn better than your fall?

[00:03:21] [SPEAKER_01] My fall is good. Honestly, it's, you know, we're recording kind of end of September. It's cool in the mornings, but it's still pretty sunny and like summery out in the afternoon. So it's kind of

[00:03:31] [SPEAKER_00] fantastic. I'm kind of enjoying it. Is this an advertisement for your podcast? I'm Alan Mead,

[00:03:34] [SPEAKER_01] and I'm cool in the morning. I am. It's cool in the morning. I would say, I would love to do, I wish I had a morning show. We all do. I wish, I wish that I could like do the,

[00:03:45] [SPEAKER_02] do the bits. That's always been my dream. If you ask like, what's my dream, dream gig, it would have been some kind of a morning, morning show. Absolutely. Why don't we all get up at

[00:03:53] [SPEAKER_01] four o'clock in the morning, every morning and do like the dental morning show? Zach's morning zoo. Yeah. Zach's dental zoo. Exactly. You know, the, the only problem with that is the getting up at four o'clock in the morning part of it. Yeah. And having guests.

[00:04:08] [SPEAKER_00] Yeah. Like, yeah, for sure. Like getting comedians on and stuff. Yeah. You gotta have,

[00:04:11] [SPEAKER_01] you gotta have someone do the, do the traffic and where we get traffic, right? For a long time,

[00:04:16] [SPEAKER_02] like I think it was Aaron Elliott used to be under a car doing a podcast with T-Bone. Yeah. Like they would like be driving and talking in their cars. I thought it was an interesting concept. I dug that. I remember listening to a few of those.

[00:04:29] [SPEAKER_01] Dennis in cars with coffee. Yeah. There you go. I feel like, I feel like someone would, would inevitably get in an accident, which would, which would be entertaining if everyone survived. If it was live captured, imagine that if it was okay, it'd be unreal.

[00:04:45] [SPEAKER_02] Yeah. Exactly. Yeah. Unreal. Uh, Alan, you have a, you have a music story for us on the, on the heels of our callback music podcast. So if people have been paying attention, uh,

[00:04:54] [SPEAKER_01] one of my favorite bands, uh, rush has been on tour for the summer and into the fall. Uh, interestingly, they added, I think they added a couple of dates in Ohio, Kevin, Cincinnati though. So it's kind of Cincinnati from where you are. I was going to say that might as well be, might as well be in, in Quebec or something. In any case, we saw my son and I went down to, uh, with two of my best high school buddies and we paid more than we probably should have

[00:05:21] [SPEAKER_01] and got moderately good tickets to see rush. I I'm not complaining. Cause I think that's just what, I don't think that's a rush thing. I think that's just the concert thing. That's a lot of money. Our seats were good though. The cool thing is about, uh, this big of a tour, every seat in little Caesars arena was going to be great because the technology was so good. They hadn't, they had a big led screen that was so clear. You could see everything. So, so the reality is no matter where you were sitting in there, you had a really good seat.

[00:05:50] [SPEAKER_01] In fact, I would have felt a little bit bummed if I had paid like the $1,500 a seat to get up close or whatever, knowing that you could see it. So anyhow, so we saw rush. It was spectacular.

[00:06:00] [SPEAKER_02] The drummer say full, well, it was little Caesars, like a, like a, one of those 16,000 seat things or like a full stadium, like 50,000 kind of pizza pizza. It's a, well, they play,

[00:06:10] [SPEAKER_01] they play hockey and basketball professional. Okay. So then it's a 20,000 seat. Yeah. I think it's a 20 to 25. It's big. It's pretty big. It's bigger than Joe Lewis was. It's bigger. So they were fantastic. Uh, the, the woman who replaced Neil Peart, uh, the drummer, one of the greatest rock drummers of all time. She did fantastic. She was great. They played all the hits, you know, they played, uh, it was, it was, they played Tom Sawyer. Did they get that one in? Of course they, they, they actually Tom Sawyer was their last. They played Tom Sawyer last before

[00:06:37] [SPEAKER_01] their encore. Okay. So, so, and they always said, they have a little shtick where they've been doing this for, for many tours where they have a, um, a South Park intro, Lil Rush, where they have, where they have, uh, um, Cartman is doing the lead vocals. And so it's, it's funny. They've been, they have, their humor is so absurd. Those guys are so, they're next level. They really are. They're really crazy. They were spectacular. It's probably the best I've seen Rush four or five times. It's probably the best time. And I think it might be

[00:07:05] [SPEAKER_01] because the people putting the show on, the mix was better. It was really loud, but you could hear everything really clearly. And I got to bring Sean, who's, who's a big Rush fan. He's never seen a rock show. So while I was there though, because we had so much fun talking about rock music and the Rock and Roll Hall of Fame and all that stuff, I felt like Kevin and Zach were kind of in the back of my mind at all pointing it out. Cause of course, Rush, Rush made the, the, I earlier in the two thousands, I think it was 2013, maybe they, they made the hall of fame. And, and I just thought

[00:07:33] [SPEAKER_01] to myself how they were, they were, uh, they were kind of second wave after the, after the really big first acts, you know, they were at one point, I think they were called the Led Zeppelin ripoff kind of band, stuff like that. They were, they were heavy in the prog rock area, but man, it was, it was great fun. And I'm like, I can see rock music isn't dead. It's not dead. It might, it's different, but it's not dead. And they were so good. I just, I just had such a fun.

[00:07:56] [SPEAKER_00] They spent a lot of time in the limelight. They did. They played that too. So, you know,

[00:08:03] [SPEAKER_02] Okay. I have a, speaking of that one more to add onto this bit before we get into the content. Um, uh, here's a rock and roll hall of fame trivia question. I'm hoping Kevin can answer this as the president, you know, person at the, there is one artist that has been inducted three different times in three different ways. Two, once as a solo artist and with two different bands. Interesting. Paul McCartney. That is not, it is not him. No. Is it Ozzy Osbourne?

[00:08:32] [SPEAKER_02] Golly Parton. No. That can't be. No and no. Um, all right. So I'm going to start to give you some, start to give you some hints. Wait, Paul McCartney would be the Beatles,

[00:08:41] [SPEAKER_01] Wings, and Paul McCartney. Was Wings, was, was Wings inducted?

[00:08:47] [SPEAKER_00] Yeah. Yeah. I had to have been, there's a Wings exhibit there now. Maybe, but, but I mean,

[00:08:52] [SPEAKER_01] they had to have been always, that never seems to work. You're right. Maybe, maybe they didn't. I feel like Boston had to have been, but they weren't. Damn it. Maybe they are. Go ahead.

[00:09:00] [SPEAKER_02] Give us some clues. Um, okay. The initial band was the Yardbirds. Oh, it's Eric Clapton. Eric Clapton. There it is. There it is. Okay. There it is. Uh, it's, I don't know. My, my AI says Eric Clapton is the only one that's in three times. Would it be Cream? Is Cream the other one? Um, let's see. Paul McCartney is in as Beatles and, huh? Say that again. I don't think Wings

[00:09:25] [SPEAKER_00] is in the Rock and Roll Hall of Fame. I think you're right that they are, they aren't. Except that there is a Wings exhibit there now, which doesn't mean anything. You're right. Yeah.

[00:09:33] [SPEAKER_01] But it says, it says Beatles. Okay. Uh, okay. Okay. Okay. But no, Paul McCartney is in as he,

[00:09:40] [SPEAKER_02] is a Beatles member and as a soloist. So he's two. So maybe he'll get a, maybe he'll pick up

[00:09:44] [SPEAKER_00] a third and something. There's always kind of, uh, there's a gray area with Wings and Paul McCartney being solo and all that. Got it. It kind of bounced back and forth.

[00:09:51] [SPEAKER_02] Anyway. Okay. So it was, it was Cream. It was Yardbirds. Cream is the other one. Yes. Yardbirds, Cream, and Solo. Okay. Yep. Okay. So he's the only one currently in as a third time. There's multiple people in twice for sure. There's a chance for you, Zach. Uh, yeah, there is. I could, I could still get started and get, get going on this. Yeah. As soon as I join your band. Yeah. Yes. Yeah. Yeah. As soon as I join your band. Okay. Uh, we're going to continue on with the avoiding patient complaints and getting ahead of it. Getting ahead of it. When it comes to snarky comments and patient complaints.

[00:10:21] [SPEAKER_02] So we talked about anesthetic last week, which was a robust conversation that went in a lot

[00:10:25] [SPEAKER_01] of the research that I didn't anticipate. We plumbed the depths. We did. Of getting ahead of it with the anesthetic. So we're going to talk about operative. Yep.

[00:10:33] [SPEAKER_02] Okay. Poster and enter operative. Um, does anyone want to start? You guys want to let me? Oh, go ahead, Zach. Go ahead. Okay. I'm going to start with some anterior operative things. Have you ever been doing an anterior operative thing? Like, especially like a facial surface or maybe one of those larger breaks and the person's teeth, you match the shade before you

[00:10:58] [SPEAKER_02] get started. And then the person's teeth dry out considerably during the appointment and they go to look in the mirror afterwards. You didn't match this right.

[00:11:09] Okay.

[00:11:10] [SPEAKER_02] Hate that. So I've always gotten in the habit of saying during this procedure, your teeth have dehydrated. The color of this restoration is going to match your teeth. Great. In about three or four hours. If not, you can call me, but I am fairly certain that's it's going to work out because that's why we've matched the shade and talked about it before we started. That's one of mine. That's the right answer. The teeth. Yep. That's the right answer. Have you guys run into the dehydrated tooth and the shade

[00:11:38] [SPEAKER_02] matching thing? Is it just me? Maybe I'm the only one who makes these kind of mistakes.

[00:11:42] [SPEAKER_01] I have, I have. I mean, the other thing is, is like anyone who's going to be a red flag for a color match. You need to have as much conversation in advance. The other thing, the other thing is I have to tell you, I have less of that because I put a ludicrous bevel on everything that's composite, anything, anything that's going to be seen. That's composite. Like I'll, if I'm doing a classified buckle on a posterior, I will bevel up to the cusp tip. It's just, that was, that was sort of a bio clear thing. You just, you just bevel. And so the longer your bevel is,

[00:12:08] [SPEAKER_01] the more it's going to blend. So you could, you could take an A35, you could take an A35 and blend it to an A2 if you have a long enough bevel. I'm convinced of it.

[00:12:17] [SPEAKER_02] Admittedly, some of today's, uh, kind of those like, uh, almost onochroma types of composites, they don't, they don't look as bad out of the gate and then they'll, they'll color correct as the time goes on too. So I agree. That's less of an issue that it used to be. It used to be more of a thing with more of the static composites.

[00:12:34] [SPEAKER_01] Also, I think, I think Saginaw teeth are, Saginaw teeth are darker than average. So I think I get away with murder because I think I have patients that are not that cosmetically driven.

[00:12:42] [SPEAKER_02] Well, there's no question. The over 65 crowd seems not to matter too much, but you better believe it matters on the like, you know, twenties crowd, it seems like. So yeah. Yeah. Uh, for what it's worth. Um, let's see. Um, anterior composites.

[00:12:57] [SPEAKER_02] I take a photo of almost every one of those like chipped teeth types of things that I work on because inevitably they are going to call, and this is getting ahead of it months down the line, months down the line and say that the filling I just did chipped.

[00:13:16] [SPEAKER_02] But in reality, it's going to be the tooth right next to it. Yeah. But they're going to, without photographic evidence, it becomes very difficult to convince them otherwise. So my getting ahead of it is. That's funny. Photograph your chipped teeth restorations because I've just run into way too many. Or you're, you do like a class three on one and then the class, the class three, the two next to it, you know, ends up failing next or something like that. Didn't you just work on this tooth? I get that. I've gotten that way too many times.

[00:13:46] [SPEAKER_01] That's a real thing. And the funny thing is first off, I'm like, well, we have a chart. We haven't, but it doesn't matter if it's in the chart. If you, yeah, the chart doesn't mean anything to them. The photographic is probably a wise choice. Cause the other thing is, you know, honestly, short of a tough occlusal pattern, bonded filling, composite fillings don't fall out. Like you can break them out or you could bust them out maybe with, if the occlusion was wrong.

[00:14:07] [SPEAKER_02] Oh, I've had plenty of those class fours, you know, fail. Shoot. I had one that I did six months ago show up today out.

[00:14:16] [SPEAKER_01] And maybe it's cause I beveled a Jesus out of everything. I don't know, but I just don't find that they fall. I find that they break more often than, well, yeah, I've missed an occlusal scheme or something like that. And they'll, they'll chip that way. But like, I don't find stuff, you know, class five sometimes, maybe more so because of the flexing of the tooth or whatever, but I just, I just don't run into that. And so I'm almost always, when they say all that thing, you just did broke out. I'm always very skeptical.

[00:14:40] [SPEAKER_02] Well, I guess when it's, when it's, when it's chipped teeth, especially like lower anterior, upper anterior chipped teeth, it just seems like every single year I'll run into someone who chips something very close to what I just did. And it, and they, it always in their mind has to be, it has to be the one that was just done. Yeah. And I get it so sick of that shit that boils my blood. And so, you know, the, it's always, it's always the assumption.

[00:15:05] [SPEAKER_01] It's always the assumption. Yeah.

[00:15:07] [SPEAKER_00] Let me take a step back from that. Photographs on all new patients, full set of photographs. So you have a record of everything looks like, and then any broken teeth. That's part of our protocol. Mainly.

[00:15:20] [SPEAKER_02] I'm not talking about a crown tooth, Kevin.

[00:15:21] [SPEAKER_00] I'm talking about that. Those need photographs.

[00:15:26] [SPEAKER_02] Well, I know, I know I am. I'm pro photographing things that need crowns. I'm just talking about you photograph your average. Yeah. Class four. Okay. Good for you. Great.

[00:15:33] [SPEAKER_00] You came in, you came in cause you just chipped it or you came in as a new patient. The photograph is going to be taken.

[00:15:42] [SPEAKER_02] Okay. Great. Then you're, you're getting ahead of it. You're getting ahead of a lot of the things by doing it.

[00:15:46] [SPEAKER_00] The photographs are getting ahead of all the whole lot of stuff.

[00:15:50] [SPEAKER_01] Tell me, tell me what, when you're doing that now, I know that you, for, for new patient exams, you're probably using a DSLR. What about on the day to day? Are you using it? I will say that someone's using it. I've got a really good way to do that with the microscope. And I don't think of it all the time. Like it's, it's literally as easy as pushing a button and I don't think of it all the time. So it is funny that like photography and not just like sexy Instagram or full. No, no, no.

[00:16:19] [SPEAKER_00] I'm not looking for that at all. Understood.

[00:16:20] [SPEAKER_01] But photography is a key on so many ways because it's like, honestly, even with really good notes, a photograph is so much better. It's so much, so much better for so many reasons.

[00:16:32] [SPEAKER_00] If they call, I can look at the photograph and say, no, that's, it's not that one.

[00:16:37] [SPEAKER_01] Yeah. You know, like. Yeah. Yeah. But me saying it's not that one, honestly, doesn't, they still think it's that one. So on some level, they need to see the photograph on some level. It's like.

[00:16:47] [SPEAKER_00] Why would they break their own teeth when they've broken them before? They have to break the thing that you did. That's. Yeah.

[00:16:53] [SPEAKER_02] Yeah. The angle is always like, I don't want to pay for something else. It's got to be what I just paid for. Of course. That's always the angle. Human nature.

[00:17:01] [SPEAKER_01] Human nature.

[00:17:02] [SPEAKER_02] That's always the angle. The angle. But yes, obviously photographing. And it was interesting. There was a, there was an entire Reddit thread on this exact topic about anterior chips. And one guy chimed, chimed in that he's like, I'll, I'll one up you. I was like, I've, there's a before and after of every single restoration I've ever done ever. Good. Whether it's an occlusal, whether it's an MO, a DO, anything. He's like, always.

[00:17:26] [SPEAKER_03] I think that's great.

[00:17:27] [SPEAKER_02] And he's like, it's, and he's like, and I'm like, that to me is, is a bit of overkill. But he said, he's like, I've never lost an argument over. Of course. Yeah.

[00:17:36] [SPEAKER_03] That's great.

[00:17:37] [SPEAKER_02] I love that. I mean, even if you have an intro camera and you're good at that. Yeah. Yeah. Yeah. That's interesting. Oh, so you don't do the after after you, after you fix the class four? I mean, I could. No, no. I'm talking to Kevin.

[00:17:48] [SPEAKER_00] Oh. I don't do many class fours, but yeah.

[00:17:53] [SPEAKER_02] You're saying you're better than me? That's what I heard.

[00:17:55] [SPEAKER_00] No, I just don't do them. But I mean, for any restoration, that would be a good habit to get into. The four is super important. Yeah. But after, I can see 100% the value. Okay.

[00:18:09] [SPEAKER_01] So assuming that it's, if you've got an assistant trained on a DSLR, then you can just tell her to do it. But what, Zach, how would you take before? Do you use an intraoral camera?

[00:18:17] [SPEAKER_02] Well, yes. I mean, I have a, I don't have one of those like intraoral, like mouthwash type cameras, but we have like a company, oh gosh, Lester Dine. Yeah. Yeah. Yeah. It sells a point and shoot camera. Oh yeah. It's not DSLR quality. No, but it's a good camera. I'm very good with that point and shoot and some mirrors. I can take photos that are good enough to convey a message. They're not going to get me on the AACD like Kevin's camera, but they're going to get the job done.

[00:18:44] [SPEAKER_01] Oh, I mean. You already know Crazy Dental has practically unbeatable prices on everyday dental supplies. 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.

[00:19:14] [SPEAKER_01] So, use VERYSHIP, all one word today. Even with a really good camera, like if I mean, I've got a really good DSLR and you know, the weakness is having it there when you need it. Oh, I have one for every room. I spent the money on that. If you're sitting there with that and it's ready to go, then that's as good as a microscope at that point for documentation. No, I'm super smart. It's the whole, if there's any foot dragging, if there's any reason to make it hard, then it's probably not going to get done.

[00:19:41] [SPEAKER_01] So, it's great that you have them in the operatory. It makes a lot of sense.

[00:19:45] [SPEAKER_00] How about this? Dental schools who are listening to this podcast, because I know all of you are, teach that class. Yes. Not as an elector. It just should be, that's the class.

[00:19:56] [SPEAKER_01] Yeah.

[00:19:57] [SPEAKER_00] You have to photograph everything.

[00:19:58] [SPEAKER_01] And if you have that on top of your clinical notes, I mean, they really add to your clinical notes. I mean, like the best clinical note probably can't do as well as a decent picture.

[00:20:10] [SPEAKER_00] Ken, I want to make an aside on that also. This AI summit that I went to last week, they're big on voice, like the microphone recording everything and transcribing everything to your notes in the operatory. Mm-hmm. And at first I was like, well, that's a big deal. But, like, that will solve a lot of problems also of the, I never said that. Sure. You know what I mean?

[00:20:36] [SPEAKER_01] Yeah. Sure. Sure.

[00:20:37] [SPEAKER_00] Do they, do they. It's like body cam.

[00:20:40] [SPEAKER_01] Yeah. Do they recommend that you, you keep the transcript? Like even.

[00:20:44] [SPEAKER_00] I think they're saved with Overjet, they save them for seven years.

[00:20:47] [SPEAKER_01] Okay. The train. Interesting. And that's. Somewhere. That's built into the, yeah. So, because I, I mean, I've used, I use one called Heidi and I don't really know, honestly, I think that I'm not sure that the transcript gets saved as much as the notes and the notes are really good. But the reality is the transcript is maybe even for, for the, he said, she said probably the transcript is better. I can't imagine.

[00:21:08] [SPEAKER_00] Also, I may have just made that up seven years, but that's what I thought I heard. So don't hold me.

[00:21:11] [SPEAKER_01] I feel like seven years is, is the number. I mean, forever.

[00:21:14] [SPEAKER_00] But think of the server space you'd have to have for that.

[00:21:17] [SPEAKER_02] Yeah. Sure. Sure. The audio files would end up taking up some space. That's why we. But I'll tell you what, photos do not take up that much space. And if it's not, if it's not a patient that's going to call you on something, maybe it's going to be an insurance. Yes. It's going to call you on something. It is a rare time when having a photo is a negative for you. That's for sure. It's almost always in your favor. One way or another.

[00:21:41] [SPEAKER_00] A hundred percent. The dentist from Kansas City, Missouri, I, behind that a hundred percent. Motion passed. Motion passed.

[00:21:50] [SPEAKER_01] So one other thing about anterior feeling. I will say this for strength. Okay. Corky, you know, Corky Wilhite, who's, who teaches for Cosmin and he does a lot of interior and stuff like that. It was something he taught me that I, I, I, I like them thick. I like front teeth thick. And so I will oftentimes tell them for strength, I made this thick. You may feel it with your tongue.

[00:22:15] [SPEAKER_00] Is that T-H-I-C-C?

[00:22:17] [SPEAKER_01] Yes.

[00:22:18] [SPEAKER_02] I like ICC. So on the lower anteriors, I will, I will build the, I will etch the whole lingual and then they just wrap the, wrap the band and build. And I said, this tooth is going to be the thickest feeling tooth down here. But if I don't do this, it's going to. That's exactly right. This isn't going to last. And that, that.

[00:22:36] [SPEAKER_01] And micro hybrids, please. Saying that in advance, really saying that you're going to do that in advance is great because then they're expecting it when you're done.

[00:22:46] [SPEAKER_02] Well, otherwise not, because I don't want to hear this feels thick to my tongue.

[00:22:49] [SPEAKER_01] I'm telling them in advance it's going to feel thick to your tongue. And it's, it's a feature where you're doing it for strength. It's a feature. Correct. So I want to tell them in advance and, and then I want to do it. Like if you're adjusting an anterior, particularly an upper anterior and you know, and, and your restoration area is getting kind of thin towards the incisal, that's going to break. A hundred percent. So you have to, you have to add probably more to the facial to bulk that thing out.

[00:23:13] [SPEAKER_02] Also, here's another anterior one. You know, when they, sometimes they'll, they'll break an upper anterior tooth. And if you don't bevel the lower, it's going to be thin, like you just said. And so a lot of times, if you look close enough to the occlusion before you start, you can get ahead of it and say, to get this done, we're going to have to shorten, bevel, change the shape. Yeah. Yeah. You know, you know, an opposing tooth to get this to work.

[00:23:40] [SPEAKER_00] Mm-hmm.

[00:23:41] [SPEAKER_02] And that way you're not built, that way you're not doing the composite. And then you're, and then instead of shaving on the composite or shaving on their tooth, and like, why are you, why are you making my tooth fit your restoration? Yes. Yes. You have to get ahead of it. You got to say that well in advance. Same thing with if you're doing a crown and you know, you got to adjust a plunger cusp, you got to get that, you got to get ahead of it before it starts, not mid procedure or

[00:24:01] [SPEAKER_01] something like that. You know, if at all possible. It's, it's, if you think it's going to happen, I totally agree. I think that's exactly right. Sure. I'm getting my, I'm getting ahead of myself by an episode, but the funny thing, the funny thing about, about the, like a, uh, an upper composite or whatever, like if you, in the same way that like polished zirconia, if you, if you don't have great polished zirconia, it really wears heavily on the opposing tooth because it's just really, really rough or whatever.

[00:24:27] [SPEAKER_01] A sharp lower anterior, uh, is you want as rounded and polished, uh, an opposing tooth as you can possibly get wherever you're working in the interior, because, because you're, you're, you want to like, I will manicure lower interiors when particularly in the old, in the 60 plus set where they've got those chipped lower incisers. Like I want that as smooth as hell before we're done with, with that, anything on the upper interior. Cause you're just going to be, it's like running sandpaper over your stuff.

[00:24:56] [SPEAKER_01] And that is, that is something I tell them before we start. If I think of, if I think, and it's like,

[00:25:00] [SPEAKER_02] Oh, here's another one for those, those like chipped and worn things. Look at their nails. Look at their nails every damn time. Because if you can get ahead of it and say, you know, uh, if you bite your nails, you know, that's the teeth win, the composite loses. If you look at the, look at their nails every time. That's so good.

[00:25:25] [SPEAKER_00] I have a question for you guys on this topic. I'm looking at you two and myself. Uh, I'm like, I'm the oldest person here. How come my teeth aren't worn to shreds? Like my patients are. And yours, you're, you're too.

[00:25:43] [SPEAKER_02] Genetics, genetic superiority.

[00:25:45] [SPEAKER_00] Well, of course I'm part of the master race. Yes. Uh, well, at least 5%. Yeah. Oh my God.

[00:25:53] [SPEAKER_01] That was a joke people. What? So what do you, why, why do you think your teeth aren't worn to hell?

[00:26:00] [SPEAKER_00] Cause I aware of my chewing and habits, I guess. I don't know.

[00:26:06] [SPEAKER_01] I just noticed that my lower end tears are starting to do that little reverse smile.

[00:26:10] [SPEAKER_00] But they're not, they're not crumbling to pieces. Not yet. Neither are yours, Zach. No. I'm working on it. Interesting. Go ahead.

[00:26:19] [SPEAKER_02] Sorry. No, no. Nail, but look at their nails. Look at the nails. You know, apnea grinding or, or, or clenching when, um, you know, and then you look at their nails and it's, that's it. You know, that's it. And nail biters are hard to get a win on. Yeah.

[00:26:42] [SPEAKER_01] I'm a nail biter too. And I have porcelain on the upper so that I probably can get away with it. Um, I just did it. I just did a porcelain. Look at the nails. I just did a porcelain veneer case this morning. I have to tell you when Zach and I hear that, it's like, that's, if I get to do that once a year, it's, it's wild. And I did this morning and this guy's, uh, his, his veneers were older than mine. So it's good. Oh, wow. You know, you know, it's going to be a win because it's like, and I, once I took them off, they were, they were, they were soft. They were like marshmallow soft.

[00:27:12] [SPEAKER_01] They came off so easily and it was like, yeah, I barely had to do anything for the prep. It was fantastic. This guy did not chew his nails. I do. And I still, I still haven't busted my porcelain off. So I'm, I don't chew my nails a lot, but I do occasionally. And that is a very good question. Yeah, I know. I can't believe I'm, I just admitted this. Shame. The shame. That's a really great, that's a really great point. Look at their fricking nails. And the other thing is, is half the time, half the time people don't even know that they chew their nails. Just you realize it's like, so on.

[00:27:40] [SPEAKER_02] So I have, I have had some successes of like getting people to finally quit. I think I can think of two confirmed cases where me talking about how they were destroying their teeth actually got them to quit.

[00:27:53] [SPEAKER_01] You know? I tell you what, that's a, that's a big win. It is. That's a big win. Like behavioral changes. That's, you've changed. Yeah. That's amazing. I know. That's amazing. Two confirmed cases. Not bad. How about that? Not bad. How about that?

[00:28:05] [SPEAKER_02] How about posterior composites? Anything, anything you try to get ahead of on the.

[00:28:10] [SPEAKER_01] Here's a, here's a trick that I've started using. Okay. So patients really numb. You're in, I like to wedge before I prep. I'll, I'll put the biggest wedge I can get in there and I don't call it a wedge. I call it a separator. Cause when they hear separator, they realize. Sounds more elegant than a wedge. Yeah. But it also, you're, when you put that wedge into place, you're fucking separating, man. You know? Like, even when they're numb, they can see. And they're like, Whoa. But you're like, my whole thing is like, I'm doing this on purpose. I'm separating this for a reason.

[00:28:40] [SPEAKER_01] And so I'm really going to do it. So don't call it a wedge, call it a separator, you know? Cause I know orthodontists have separators that they use, you know, prior to placing bands or whatever, but this is, this is a short-term separator. But I think all of a sudden when you do that, then when you're matrixing and you're, you're putting a ring on it and there's all this crazy pressure there, they're ready for it. Cause you call it a separator.

[00:29:01] [SPEAKER_02] There's no question that every time before I put a wedge in, I, you know, let them know, Hey, there's, there's some pressure.

[00:29:06] [SPEAKER_00] You're going to feel some pressure. Yeah.

[00:29:07] [SPEAKER_02] Yep. Now I'm amazed some people that is, you know, can't handle that. You almost have to do one of those papilla shots. Yeah. Yeah.

[00:29:16] [SPEAKER_01] Well, I'll do it if they, if they wince, I will do that. I don't do it all the time, but I do. No, I don't do it very often at all. I do it more than I do it more now than I ever have. Cause I can't, you know what? I kind of don't want to hear it.

[00:29:26] [SPEAKER_03] Yeah.

[00:29:27] [SPEAKER_01] That's getting ahead of it in a way too. Yeah. You know, that's getting ahead of it in a way. I don't hear you bitch. I've said this a million times. I am heavy on the PDL shot and not into the ligament. Well, I'm not talking about the PDL.

[00:29:37] [SPEAKER_02] This is like one of those like intrapapillar, like you're going from one side through to

[00:29:41] [SPEAKER_01] the. Yeah. Yeah. I guess I use the PDL syringe to get the papilla tissue around it numb. I, I, I don't actually use it for a PDL injection very often. It's almost always for a tissue injection around the tooth. Like if I'm placing a dam, uh, endo restorative, whatever I get the circumferentially around the tooth, I'm putting the ring on every time. And I tell them cause I don't want, I don't want them to complain about that.

[00:30:04] [SPEAKER_00] Go ahead. That's a good, good point. The rubber dam.

[00:30:07] [SPEAKER_01] Yeah.

[00:30:07] [SPEAKER_00] Getting ahead of that.

[00:30:09] [SPEAKER_01] Yeah. How do you get, how do you get ahead of the rubber dam?

[00:30:12] [SPEAKER_00] I force, I, I, uh, I use, um, I don't know what the proper term is. You go by force. You just, you just, yeah. Punch him. I say something like, uh, as I'm doing it, this is the rubber screen we're going to put. This is the rubber screen. We're going to put this on to help keep your lip and cheek out of the way. Boom. It's in no objections. I don't give them, I don't, I don't give them any time to do that. Right.

[00:30:40] [SPEAKER_00] And the weird thing is when I was younger, Kevin, people would, I, you would overexplain remember people walking out.

[00:30:48] [SPEAKER_01] Yeah.

[00:30:49] [SPEAKER_00] Yeah. Like don't ever do that to me again. Yeah.

[00:30:52] [SPEAKER_01] And I find myself getting in trouble when I overexplain it.

[00:30:56] [SPEAKER_00] Yeah. Don't talk too much about it. I, I'm just going for it.

[00:31:00] [SPEAKER_02] And under, I agree. I don't, I don't, I often don't give a choice. I just say, Hey, we're going to put the cover on your tooth. That, you know, isolates it, keeps it dry, keeps it, keeps the, keep, oh, it's disinfected, whatever, whatever it is.

[00:31:11] [SPEAKER_00] So yesterday we had an emergency endocrine and I started, I did my little rubber damage spiel and the guy said, with the rubber dam on, he's like, what he was saying was, I've never had this before. Yeah. And I, I, I just met the guy and I was like, oh, it's cause you never had a root canal before or whatever. And he's like, yeah, I have.

[00:31:35] [SPEAKER_01] I'm like, oh, I was just going to say, you look at his x-rays, he's got root canals. He's never had that before. That's that. Honestly.

[00:31:41] [SPEAKER_00] Number 30 with root canal. I just forgot. Cause I was kind of turning around number two or whatever.

[00:31:45] [SPEAKER_02] Yeah. Right.

[00:31:46] [SPEAKER_00] Okay.

[00:31:48] [SPEAKER_02] Yeah. Yeah. That's a, that's, I don't know what to say about that, but yeah, that's rubber damage are definitely a good thing to get ahead of as well. Uh, other posterior, besides the wedge, anything other posterior composite things you, I always tell them anytime we're working in between the teeth, your gum's going to be sore. Yeah. You know, afterwards to kind of get ahead of that. So I don't get the call back of it. You know, my gum's really sore around where this. Yeah.

[00:32:12] [SPEAKER_01] I got to tell you that, uh, I know I've said this before on, on the podcast and this isn't a patient objection per se. Like if the contact isn't, isn't really good, the time to fix it is now. Don't you? Of course. Yeah. Oh yeah. You're going to see it on the schedule because they're going to, it's going to drive them nuts and drive them crazy. So yeah. I mean, it says a guy who has a couple of those that fucking drive me crazy. So yeah.

[00:32:35] [SPEAKER_02] Yep. But no, just like I said, I think, I think when it comes to that particular procedure with posterior composite, you've talked them through the wedge, talking to the ring, putting some pressure on the, some pressure on the tooth and talking to the rubber dam part of it. Um, the rest of it kind of is no different than any other things that we've, yeah.

[00:32:53] [SPEAKER_01] Yeah.

[00:32:53] [SPEAKER_02] We've taught, we've, we've talked about for the most part. Do you talk about sensitivity? Do you preempt them on this tooth may have some temperature sensitivity after what's your preempt on that?

[00:33:03] [SPEAKER_00] My standard when you're leaving, whatever restorative we've done, you might feel some sensitivity in that tooth. That's normal. Yep. It'll go away. Yep. Just like very simple to the point. That's normal. It'll go away. Again, this is a place where. Most of the time it will.

[00:33:18] [SPEAKER_01] If you over, if you over explain, they're going to be, they're going to be up in their head a little.

[00:33:24] [SPEAKER_00] Get in their head. Yeah.

[00:33:25] [SPEAKER_01] Sure.

[00:33:26] [SPEAKER_02] I am also, I also hand out Sensodyne like, like candy, like just saying, getting ahead of it. Like you probably ought to use this for a while. This, this tooth, I plan on this tooth being a little cold. That's actually great.

[00:33:39] [SPEAKER_01] That's actually great because most of the time they're not. The little sample sizes, you know, I guess I give those out a lot. Most of the time they're not sensitive, but if you tell them they're going to be sensitive and they're not, then they think they're, they're winning the game, right? Like that's the, I think that's really. They beat the system. Exactly. If you kind of get with, particularly with all operative, if you can get their expectations down a little bit, especially if you know what you're doing, you usually do pretty well with it. Honestly, I, I get the least, I probably get the least amount of complaints from, you know,

[00:34:09] [SPEAKER_01] posterior operative. Typically it's, it's, if I have a weak contact and I'm, I'm, and if I was too weak to fix it at the time, I, if that's when I usually get it, other than that, most of the time feelings do okay. And I'm not saying I never have post-operative sensitivity, but post-operative sensitivity is worse when it's really deep and it might need to know. That's the story. So yeah. Tell them that in advance.

[00:34:29] [SPEAKER_02] And it will, and hopefully you've had that. That's, I mean, that's almost part of like an informed sense. Yeah. Consent conversation to begin with that. That's, you know, that's almost different than. I agree. What we're going for, but same, same idea. Yeah.

[00:34:40] [SPEAKER_01] All right.

[00:34:41] [SPEAKER_02] I agree. Well, Hey, we're up against it yet again. We are. 30 minutes. Just like that. I love it. So run away. Piece of cake. Kevin, any, uh, take that, take backs, double downs, regrets.

[00:34:53] [SPEAKER_00] Um, Paul McCartney should be in three times.

[00:34:56] [SPEAKER_02] I agree. Yeah. That is a good double down.

[00:34:58] [SPEAKER_00] It, it, it's news to me that wings is not in the rock and roll hall of fame with all our conversations from months ago, that is a band that should be in the rock and roll hall of fame.

[00:35:08] [SPEAKER_01] The problem is because they don't have that big of a catalog maybe.

[00:35:12] [SPEAKER_00] Well, they have a huge catalog. They have a huge catalog, but there's only interesting. Yeah. They have a huge catalog, but the other problem is the, uh, Linda's dead and Danny Lane is dead. And the other, there was always a mix of other people. People in the background. So people think of the music as Paul McCartney.

[00:35:30] [SPEAKER_02] So in other words, this is like a take back from like 10 episodes ago when we were talking about snubs and you didn't mention wings.

[00:35:37] [SPEAKER_00] I just figured they were in. Yeah. I just figured they were in. Yeah. Why wouldn't they be?

[00:35:40] [SPEAKER_02] What an opportunity missed. You could have had a whole conversation about Paul and wings. Yeah.

[00:35:44] [SPEAKER_00] Yeah.

[00:35:45] [SPEAKER_02] I feel like we need to be a little bit. It's such a bummer. Yeah.

[00:35:48] [SPEAKER_00] There's Paul solo. Then there's wings. And there's Paul solo again. Yeah. And the bookends of the Paul solos are very interesting, but I digress. Yes. I know way too much about that. Go on.

[00:36:01] [SPEAKER_02] Carry on. How about Alan? How about you? Take backs, double downs.

[00:36:04] [SPEAKER_01] I'm impressed. I'm impressed that Kevin doesn't do any class fours. Because I have to, I love class fours.

[00:36:11] [SPEAKER_02] I think it's because Matt does the class fours. I don't think that Kevin magically doesn't fix chip keep. He's got a class four guy is what we're saying.

[00:36:18] [SPEAKER_00] I think it's because we do some, a lot of crowns.

[00:36:21] [SPEAKER_01] All right. That's fair. But there are some patients that probably need class fours.

[00:36:25] [SPEAKER_00] A hundred percent. There's some, there's some that are smaller chips that I do not.

[00:36:30] [SPEAKER_01] I love, I love class fours. I love class fours. And the secret to class fours is, yeah, I do. Don't, if you're doing a class four cover, the entire facial, no matter what, with a big ass bevel. That's a lot of work. Or just crown. Yeah, you're probably right. Yeah, or at that point, I just put a crown on it. Sure. I suppose that's fair. But no, that's good. That's my take back. Good. That's good.

[00:36:50] [SPEAKER_02] I double down on the look at the nails thing. It's going to save your ass. That's really good. On some case, someday, whether it's, whether it's a crown or whether it's a filling, the nail biter can destroy it.

[00:37:02] [SPEAKER_00] So Zach, I'm going to think of you always now as a nail guy. Yeah. You know, like some people look at, you know, you're a nail guy.

[00:37:11] [SPEAKER_02] That's right. Yeah, that's right. That's right. Absolutely. But much like the, much like the, I don't know, it's the opposite. It's mostly dudes. Yeah. It's mostly dudes that are the nail liners for sure. Yeah. Yeah. For sure.

[00:37:26] [SPEAKER_00] Hey, my eyes are up here.

[00:37:30] [SPEAKER_02] All right. Thank you guys for listening. And this, this series continues. We haven't even gotten to extractions, crowns, implants, dentures, partials.

[00:37:39] [SPEAKER_01] If you have suggestions for what we should talk about, put them in the, put them in one of the groups, very clinical or very done. Yeah. Yes. Absolutely. I'm sure, I'm sure there's more that we missed. Yeah. If we miss stuff too, you just, just shame us in the Facebook groups. We're here for it. Yeah.

[00:37:54] [SPEAKER_00] Shame does wonders.

[00:37:55] [SPEAKER_01] Thank you guys for listening. And we will see you next Tuesday.

[00:37:58] [SPEAKER_03] See ya.