Very Clinical: The End of the Line (aka: Terminal Dentition)

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[00:01:04] [SPEAKER_02]: This is a production of the Very Dental Podcast Network. Welcome to the Very Clinical Podcast!

[00:01:22] [SPEAKER_02]: In about the time it takes to do an MO on 3, we will entertain and amaze you with tips

[00:01:27] [SPEAKER_02]: and tricks on regular daily dentistry. Here's Kevin and Zach. Puyakasha,

[00:01:33] [SPEAKER_03]: very clinical listeners and welcome back to another episode of the Very Clinical Podcast.

[00:01:39] [SPEAKER_03]: I am Zach Miners coming to you from mighty Missouri and with me I have my trusty co-host,

[00:01:44] [SPEAKER_03]: Kevin Hare Friar. What's up Kevin? Yo yo yo how's it going?

[00:01:50] [SPEAKER_03]: It's summer, I love it. And the water's getting warm and getting ready to be some

[00:01:56] [SPEAKER_00]: good boating and swimming season. Yo we had a couple of warm days in a row here so that's

[00:02:01] [SPEAKER_00]: really nice. Zachary did you go to a baseball game? I finally got back to a baseball game,

[00:02:07] [SPEAKER_03]: yes. At school? I loved it. Kevin that felt so good to get back out to the ballpark.

[00:02:15] [SPEAKER_00]: That was really great. Did you have some peanuts and cracker jack?

[00:02:20] [SPEAKER_03]: No I did not and let me tell you why because MLB wide you've always been able to bring in

[00:02:27] [SPEAKER_03]: your own peanuts and stuff instead of paying the absorbent fees. Also the peanuts that they

[00:02:31] [SPEAKER_03]: sell inside MLB Stames at least in Kansas City are total garbage. I like I am a peanut snob,

[00:02:37] [SPEAKER_03]: I want better peanuts not buying those crappy peanuts so I did not and because you can't bring

[00:02:43] [SPEAKER_03]: in food anymore F you MLB I'm not gonna eat them. So you zam your peanut products and

[00:02:50] [SPEAKER_00]: snacks at a baseball game. Yes. So you went to a baseball game in the

[00:03:00] [SPEAKER_00]: aftermath of the pandemic how was that? It was good it was right before they just a couple

[00:03:06] [SPEAKER_03]: of days later the Royals opened up the stadium to full capacity which people will never sell

[00:03:14] [SPEAKER_03]: full capacity but you can you have the option to go full capacity so I was still there when

[00:03:19] [SPEAKER_03]: it was at one third and frankly on this night even if it had been full capacity that's all

[00:03:24] [SPEAKER_03]: they would have sold anyway but it was it was great it was no masks it was great being out

[00:03:29] [SPEAKER_03]: there I was out there with buddies enjoying the game and I didn't I didn't even realize

[00:03:33] [SPEAKER_03]: how much I missed that or how much not having that affected me affected me because

[00:03:38] [SPEAKER_03]: I'm a guy that goes I go to eight to ten games a year I love baseball.

[00:03:41] [SPEAKER_00]: So last year mid April or May we had a podcast and I made the declaration that the pandemic

[00:03:50] [SPEAKER_00]: will be over when you can go to a major league baseball game. What did I know

[00:03:55] [SPEAKER_00]: that it would be a whole nother year? Yeah. But hey I think that that's a great

[00:04:02] [SPEAKER_00]: a great thing and I was happy to see that you went I have not been to an Indians game yet

[00:04:10] [SPEAKER_00]: last year was the first time except for the year my son was born and maybe a couple years

[00:04:17] [SPEAKER_00]: in dental school that I didn't go to one Indians game which really kind of bummed me out.

[00:04:23] [SPEAKER_03]: I would have to I mean I'd have to go back to

[00:04:27] [SPEAKER_03]: the Royals just part of my either myself or my parents have always had like a quarter season

[00:04:34] [SPEAKER_03]: pass or a like a 10 game pack we've had that even since before like we won the series in 85 I mean

[00:04:42] [SPEAKER_03]: so we're going back to like I'm six seven years old before I you'd get to a year where I didn't

[00:04:47] [SPEAKER_03]: attend a baseball game you know and usually multiple baseball games. And how are your Royals

[00:04:53] [SPEAKER_00]: doing this year they are a couple games behind the Cleveland Indians I see. They are. You know

[00:04:59] [SPEAKER_03]: what we're playing 500 ball and there was a there was a bad losing streak Cleveland swept us out on

[00:05:05] [SPEAKER_03]: yeah whole series not too long ago which sucked but you know what they had been really really bad for

[00:05:13] [SPEAKER_03]: a few years after after the they won the series in 15 and this year we're finally playing ball

[00:05:18] [SPEAKER_03]: to the point where I can turn it on and feel like oh there's a you know decent chance

[00:05:22] [SPEAKER_00]: that'll be a decent game. Well we got rid of everyone so it's I hardly know who's on the

[00:05:27] [SPEAKER_00]: team. I watched I've watched a couple games but I'm not into it like I used to. Currently we're playing

[00:05:32] [SPEAKER_00]: the Cardinals though that's an inter league when this comes out no one will really care. No like a

[00:05:38] [SPEAKER_00]: month from now but how do you feel about that their inter league play. So okay so when it was

[00:05:46] [SPEAKER_03]: first introduced one of the things that they were going to bring is the St. Louis Cardinals

[00:05:51] [SPEAKER_03]: versus the Royals which that's a nice that's a regional rivalry. They met in the 85 series that was

[00:05:59] [SPEAKER_03]: a massive deal for Missouri you know for two Missouri teams being the World Series back in the 80s

[00:06:05] [SPEAKER_03]: I mean you can't understate how big of a deal that was so I've been kind of anti-Cardinals

[00:06:11] [SPEAKER_03]: ever since that World Series and so when that came I was like oh inter league plays awesome

[00:06:18] [SPEAKER_03]: what he has taken away is the fact that now when there's a World Series matchup and the teams have

[00:06:24] [SPEAKER_03]: met in the regular season I hate that. I hate that too. So now that the Cardinals like seeing them

[00:06:31] [SPEAKER_03]: has worn off it wore off a long time right I wish there was not inter league play.

[00:06:36] [SPEAKER_00]: So here's my premise as a kid growing up in the 70s I would rarely if ever be able to see

[00:06:45] [SPEAKER_00]: Hank Aaron play or Roberto Clemente or even like Willie Mays or something like that that would be

[00:06:53] [SPEAKER_00]: a near impossibility for three players who primarily played in the National League

[00:07:00] [SPEAKER_00]: because there was no ESPN or Sunday Night Baseball or whatever now I could subscribe to some

[00:07:11] [SPEAKER_00]: you know MLB network or whatever and see every single game and know who everybody is so

[00:07:17] [SPEAKER_00]: I don't need that National League star superstar to come to my city because I can even

[00:07:26] [SPEAKER_00]: watch just watch the highlights on ESPN sure which you wouldn't necessarily see maybe on a

[00:07:34] [SPEAKER_00]: you know when there were three channels and you know the local sports they might show because

[00:07:39] [SPEAKER_00]: you know you know someone hit a home run or something that might be the highlight for two

[00:07:46] [SPEAKER_00]: seconds but you didn't really get to know them you could you could follow any team you want

[00:07:50] [SPEAKER_00]: and watch every single game now it doesn't make any sense to me at all and it does take

[00:07:55] [SPEAKER_00]: away from the World Series in my opinion I don't like it. I'm with you I'm with you

[00:08:03] [SPEAKER_03]: all the way on that now Kevin are you and a baseball fan to the point where you have a

[00:08:08] [SPEAKER_03]: opinion or take on this whole you know strikeouts and home runs era the launch angles and

[00:08:15] [SPEAKER_03]: stuff they're put on the balls and low betting averages and all that. I will admit that my

[00:08:21] [SPEAKER_00]: following a baseball over the past five years has probably fallen off well since the 2016 World

[00:08:29] [SPEAKER_00]: Series where we you know yeah that was like a dagger to the heart. That is that what that's

[00:08:36] [SPEAKER_00]: tough. But if you're a historian of baseball these things go in waves and you know

[00:08:46] [SPEAKER_00]: the low batting average the high strikeout those things tend to balance themselves out over long

[00:08:54] [SPEAKER_00]: periods of time. The game is basically based on math you know to a certain degree and you know

[00:09:03] [SPEAKER_00]: that they will either adjust the rules or enforce the rules. I mean people have been putting stuff

[00:09:09] [SPEAKER_00]: on the ball forever. That's not I mean I when I grew up Gaylord Perry was pitching for the

[00:09:15] [SPEAKER_00]: Indians and he you know he was known for throwing a spitball. That's that's you know that that

[00:09:22] [SPEAKER_00]: that's the name of his biography me and the spitter look that up people who are ancient.

[00:09:27] [SPEAKER_00]: So I know that's been going on forever. I think one of the

[00:09:33] [SPEAKER_00]: one of the sort of

[00:09:37] [SPEAKER_00]: what's the right word cute things about baseball is that it involves cheating to a certain degree.

[00:09:45] [SPEAKER_03]: Yeah it has been it has been known for that for years. I'm with you Kevin. I agree all they

[00:09:50] [SPEAKER_03]: just ban the shift lower the mound you know they'll they'll fix it with rules. Yeah sports sports

[00:09:56] [SPEAKER_03]: always tends to find a way to like fix something with rules after the players and coaches figure

[00:10:03] [SPEAKER_00]: out a way to exploit it. It's amazing to me that more batters can't fool the shift but I

[00:10:08] [SPEAKER_00]: guess that's you know if you're if you're pitching inside to a power hitter he's going to

[00:10:14] [SPEAKER_00]: you know hit the ball to where you have the shift shifted. Yeah so it's it makes sense

[00:10:19] [SPEAKER_03]: that's how it works ban the shift hashtag ban the shift. Right all right so I could talk

[00:10:26] [SPEAKER_03]: baseball with you for another three minutes easily but I don't think that's why people

[00:10:30] [SPEAKER_00]: tuned into the very clinical no we just lost everyone after this nine minutes but whatever

[00:10:35] [SPEAKER_03]: probably yeah probably except for Josh Austin if he happens to tune into this episode he's

[00:10:40] [SPEAKER_03]: listening but everyone else tuned out let's talk about so you and I have had a little bit of

[00:10:47] [SPEAKER_03]: ongoing discussion and online in our clinical very clinical chat about some terminal little

[00:10:56] [SPEAKER_03]: dentition cases and yeah maybe when you pull the cord and I've had some I've had some tough

[00:11:00] [SPEAKER_03]: decisions lately where I didn't know whether I should keep fixing someone's teeth or whether

[00:11:07] [SPEAKER_03]: it was just time to be be done with it and I want to know if you have a take on

[00:11:14] [SPEAKER_03]: patching and saving and stfing and all that versus it's it's time to end it. Yeah I think a lot of it

[00:11:22] [SPEAKER_00]: depends on the patients wants and also their age to a certain degree so recently I had two

[00:11:32] [SPEAKER_00]: patients that fit that category had a guy come in with a bunch of broken off teeth some perio

[00:11:39] [SPEAKER_00]: you know and just flat out asking them you know when you take clinical pictures put them up

[00:11:45] [SPEAKER_00]: in front of the patient and they can see the wreck that is going on in their own mouth

[00:11:51] [SPEAKER_00]: and just simply ask them what do you think about this there's you know there's some of those

[00:11:57] [SPEAKER_00]: where it's sort of a no-brainer you you need a denture that's all there is to it

[00:12:02] [SPEAKER_00]: and if you can get the patient to say that then you've you've sort of won you've won a little

[00:12:08] [SPEAKER_00]: bit of a battle down down that road this particular guy that I'm thinking about again had a mix of

[00:12:13] [SPEAKER_00]: perio and and decay and a bunch of missing teeth and a bunch of missing strategic teeth so

[00:12:19] [SPEAKER_00]: it was sort of a no-brainer but that's what we needed to do contrast that with patient

[00:12:24] [SPEAKER_00]: I saw yesterday she's like 78 years old a bunch of old crowns not very healthy

[00:12:34] [SPEAKER_00]: you know on a bunch of blood pressure medications heart medications diabetic all that sort of stuff

[00:12:42] [SPEAKER_00]: and she has a bunch of decay around some old crowns there's no way I'm going to recommend

[00:12:49] [SPEAKER_00]: you know to do a full mouth of crowns on this lady I'm content to patch what's there and hope for the

[00:12:58] [SPEAKER_00]: best and more than likely you know she's not unfortunately probably not going to live that

[00:13:07] [SPEAKER_00]: long and that's okay so a lot of it is a lot of it comes down to meeting the patient where

[00:13:14] [SPEAKER_00]: they're at and a lot of it I think is due is dependent on age so I think it's easier to

[00:13:26] [SPEAKER_03]: tell someone you know that maybe has in rough shape that they need a denture when maybe they're a

[00:13:32] [SPEAKER_03]: newer patient yeah to you so I feel like this is an area where I struggle and I've talked to my

[00:13:38] [SPEAKER_03]: dad quite a bit about this as well and and he he's admitted that he's probably made some

[00:13:42] [SPEAKER_03]: some incorrect treatment planning choices on this as well and that's the person that

[00:13:47] [SPEAKER_03]: that you've seen for 15 20 plus years you've done a lot of this restorative work

[00:13:57] [SPEAKER_03]: and you know maybe it's maybe it's had a good run and now it's starting to fail and you can

[00:14:02] [SPEAKER_03]: tell that like the person is failing is failing but it's like you don't want to

[00:14:10] [SPEAKER_03]: you don't want to see this person end up in a denture and maybe they don't even want to end up in

[00:14:15] [SPEAKER_03]: a denture on your watch yep and you and you hate looking at your own work failing so you're

[00:14:20] [SPEAKER_03]: patching this and you're like we can rig that and do that you know because you're just trying to

[00:14:25] [SPEAKER_03]: keep the lifespan of your stuff right you did going and it's irrational and another dentist

[00:14:31] [SPEAKER_03]: that hadn't seen the person wouldn't do any of that but somehow there's this I think

[00:14:35] [SPEAKER_00]: investment there's some emotional investment a little bit of ego and a little yes all those

[00:14:40] [SPEAKER_00]: things person for so long there's a patient that fits that category completely actually

[00:14:46] [SPEAKER_00]: just passed away two months ago he was the dad of a long-term patient who I'd seen for a long time

[00:14:51] [SPEAKER_00]: done a bunch of crowns bunch of fillings and think you know the daughter I'm fairly good

[00:14:57] [SPEAKER_00]: friends with as a patient you know and she would admit her dad just sits around and eats

[00:15:02] [SPEAKER_00]: M&Ms all day long and you know he doesn't have much to do with his life anymore and there's a bunch

[00:15:07] [SPEAKER_00]: of cervical decay and the kind that you know you you see him for one thing and the next time you

[00:15:12] [SPEAKER_00]: see him there's you know five more areas of decay but that was this exact scenario I was too

[00:15:21] [SPEAKER_00]: I didn't want to give up on what I had done and they actually did go somewhere else to get

[00:15:27] [SPEAKER_00]: a consult and they recommended you know taking everything out in their denture and then they

[00:15:31] [SPEAKER_00]: came back to me and said you know can you do this I'm like sure I can do that but you know it's sort

[00:15:38] [SPEAKER_00]: of had to be pushed from somebody else recommending it so I get it I get it so that's a tough one

[00:15:47] [SPEAKER_03]: it is tough and so and I've actually and I've had like a patient outcomes on

[00:15:54] [SPEAKER_03]: on both sides of it where on one hand someone you know left the practice because like I think

[00:16:03] [SPEAKER_03]: that they were thinking that it was stupid to put money more money into their teeth and

[00:16:06] [SPEAKER_03]: I was like oh man I don't want you to see go to a denture but then I've had the other scenario

[00:16:11] [SPEAKER_03]: where I was like okay look you just the decay doesn't isn't stopping we it's time to be done

[00:16:18] [SPEAKER_03]: with this and they weren't done with their teeth and so then they left for that reason

[00:16:25] [SPEAKER_00]: they're probably all the same place though probably right I mean same outcome and

[00:16:33] [SPEAKER_03]: and then on on top of that I've had the person where you know the worst you densurize them

[00:16:41] [SPEAKER_03]: and then it's like oh god if I would have known it was going to be this much

[00:16:45] [SPEAKER_03]: pain and this many appointments and this guy would have never done you know so you just feel

[00:16:51] [SPEAKER_03]: you feel like you've socked the person to a bad solution you know I had teeth now I have no teeth

[00:16:57] [SPEAKER_00]: you know that's yeah I'm I'm sure everyone does this but that's where I really have the heart to

[00:17:02] [SPEAKER_00]: heart sit down at their level eye to eye and say you know a denture is a prosthetic just

[00:17:08] [SPEAKER_00]: like you had a prosthetic leg it's not the same like and this decision to remove all your teeth is

[00:17:15] [SPEAKER_00]: not something that I take on lightly once I take them out I can't put them back in and even if you

[00:17:21] [SPEAKER_00]: have this discussion that doesn't mean that two months from now they're not gonna you know

[00:17:25] [SPEAKER_00]: they may not remember it when they're suffering with their denture but on the other hand

[00:17:30] [SPEAKER_00]: you know they put themselves in that position none of us are you know you see some of these

[00:17:35] [SPEAKER_00]: weird things online where it looks like people have healthy teeth and all of a sudden they're in

[00:17:40] [SPEAKER_00]: all on four or they've been uh edentialized none of us are really going to do that right

[00:17:45] [SPEAKER_00]: this decision is not something that any of us are going to take lightly um so I think that

[00:17:53] [SPEAKER_00]: what you say to the patient particularly at the beginning middle and end of that is going to

[00:17:59] [SPEAKER_00]: help with the heartache but a lot of those you know the decision has already been made

[00:18:03] [SPEAKER_00]: by the patient and as time has gone on I am less forgiving or way less heroic if the writing

[00:18:12] [SPEAKER_00]: if the writing's on the wall we're just going to go straight to it you're just delaying the

[00:18:17] [SPEAKER_03]: inevitable on a lot of these people Kevin what's your what's your personal

[00:18:23] [SPEAKER_03]: comfort level and experience level with just the conventional dentures do you feel you

[00:18:30] [SPEAKER_03]: feel good about your denture game medium like where are you at with yeah what I always tell the patients

[00:18:35] [SPEAKER_00]: is I you know I've made hundreds of dentures and the technique is always the same but what's

[00:18:41] [SPEAKER_00]: always different is the patient the patient that changes so they have a lot to do with it

[00:18:48] [SPEAKER_00]: I feel pretty comfortable with it um I you know I've certainly had some hits and misses

[00:18:56] [SPEAKER_00]: some swings and misses if we're going back to the baseball yeah I was gonna say nice nice tie in there

[00:19:02] [SPEAKER_00]: but um you know ultimately the patient has to wear it and you know it's um the technique is

[00:19:17] [SPEAKER_00]: sound um but you know like I said it's the patient that that is changing in this scenario

[00:19:25] [SPEAKER_03]: I I think one of my also maybe personal weaknesses as a as a clinician would be that

[00:19:33] [SPEAKER_03]: because I feel so mediocre about my uh preprocessed surgery yeah and and my denture game

[00:19:43] [SPEAKER_03]: that's that makes me someone who's maybe a little bit more likely to hang on to teeth

[00:19:50] [SPEAKER_03]: that shouldn't be hung on to so I I don't know I need Russell Schaefer I need your I need you to

[00:19:57] [SPEAKER_03]: get back on the course game I need to get in yeah I need to get going I I will say it's one of the

[00:20:03] [SPEAKER_00]: things I do enjoy I mean if it um you know doing a full mouth extraction on an immediate

[00:20:09] [SPEAKER_00]: denture it's it is kind of it's kind of fun um life she liked that yeah it's especially

[00:20:17] [SPEAKER_00]: if you're going to put a couple of implants in that changes things yes that makes it even more fun

[00:20:25] [SPEAKER_00]: so yeah I think you know like my ears perk up when I see one of those patients roll through as a

[00:20:32] [SPEAKER_00]: new patient like you know this this could be you know a lot of fun and life changing for

[00:20:38] [SPEAKER_00]: for the patient but you know it can also be a big headache for everyone involved

[00:20:43] [SPEAKER_00]: you know you're sure you're taking a risk there for sure but um yeah it's um it's one of those things

[00:20:51] [SPEAKER_00]: in in our career that you know it can be um it can be a great boon for everybody including

[00:21:00] [SPEAKER_00]: the patient and the practice or it can be a total drag so are there some like uh

[00:21:09] [SPEAKER_03]: hard and fast rules or like a decision tree or matrix that you use when you're kind of considering

[00:21:19] [SPEAKER_03]: um restoring teeth versus a partial denture versus a full denture do you have like a

[00:21:26] [SPEAKER_03]: you know kind of a decision tree or criteria in your in your mind that you use or is just

[00:21:32] [SPEAKER_00]: kind of a gut thing it's probably more of a gut thing I mean key teeth missing or key key teeth that

[00:21:38] [SPEAKER_00]: can't be restored like upper canines or something like that then you're starting to go downhill

[00:21:44] [SPEAKER_00]: pretty rapidly um uh you know a bilateral lower-edential span that you can't put an implant in

[00:21:55] [SPEAKER_00]: I'm certainly willing to make a partial although honestly I probably only make a handful

[00:22:01] [SPEAKER_00]: a year if that um you know it it's probably more of a gut feeling also you know taking

[00:22:12] [SPEAKER_00]: the periodontal condition into consideration is certainly a part of all that

[00:22:20] [SPEAKER_03]: yes I mean we talk we were talking mostly more about decay in the prior discussion but I agree

[00:22:28] [SPEAKER_03]: the period can be the same slope it's like when do you when do you stop you know trying to root plane

[00:22:35] [SPEAKER_03]: or put in 92 units of arrest and or whatever into these some of these pockets before it's

[00:22:42] [SPEAKER_00]: it's over yeah I'm probably more apt to um jettison the upper teeth and try to hold

[00:22:50] [SPEAKER_00]: up onto anything I can on the lower but that that's also been that's also been changing with

[00:22:55] [SPEAKER_03]: placing more implants um and I mean I think that brings up a yet maybe another

[00:23:05] [SPEAKER_03]: you know decision point in the tree is is is maybe what the financial considerations

[00:23:11] [SPEAKER_03]: you know are with someone you know it's it's it is it's a lot easier to recommend that lower

[00:23:18] [SPEAKER_03]: denture if you know that you know you know for for implants or or something like that can be

[00:23:25] [SPEAKER_03]: can be part of it versus if it because if it's if it's going on nothing you you know what you're

[00:23:30] [SPEAKER_03]: getting you know you're getting you're getting absolutely you're getting absolutely nothing

[00:23:35] [SPEAKER_03]: I think I've I've hung on to or tried to maintain some partials on the lower knowing that you

[00:23:44] [SPEAKER_03]: know once that went yeah that we were in a bad spot and that maybe implants were going to be a

[00:23:48] [SPEAKER_00]: tough you know a tough sell right yeah I mean you know I've gotten more comfortable just asking the

[00:23:58] [SPEAKER_00]: patient what you know what their budget is and if it's not even you use that question yeah okay because

[00:24:04] [SPEAKER_03]: like I all right I I've heard uh what is it who's it that tells you to ask that question it's uh

[00:24:12] [SPEAKER_03]: Paul homily always talked about that that I have never once had that question work favorably for me so

[00:24:19] [SPEAKER_00]: all right now I'm all ears like tell me okay so I had I had someone in last week who

[00:24:27] [SPEAKER_00]: it's she's not at she's young it's not a denture case it's a decay case it's probably going to end

[00:24:32] [SPEAKER_00]: up being a full mouth rehab probably with some bridges because she doesn't have a bone

[00:24:37] [SPEAKER_00]: bone width for implants okay but anyway she was a brand new patient she was really

[00:24:43] [SPEAKER_00]: very personable lady and you know we sort of hit it off right from the beginning

[00:24:52] [SPEAKER_00]: but in my mind this is going to be a 12 to 20 thousand dollar case so I don't want to go too

[00:25:00] [SPEAKER_00]: far down the road without asking her you know what's your budget right for this and I didn't get a

[00:25:08] [SPEAKER_00]: direct answer all I got was I have some savings I know I need to do this so I wasn't gonna you know

[00:25:15] [SPEAKER_00]: what am I supposed to say to that you know what is your bank account number supposed to use the

[00:25:22] [SPEAKER_03]: have you ever seen the uh the uh walley world vacation movie yeah well you know the car

[00:25:28] [SPEAKER_03]: crashes card and the the repair guys if you know you run it off that that jump right uh hey all right

[00:25:35] [SPEAKER_03]: guys how much is it well how much you got right now I know stop messing around stop messing around

[00:25:40] [SPEAKER_03]: how much is it and they just started pounding the wrench into his hand I said how much you got

[00:25:46] [SPEAKER_00]: yeah so that your that's your tactic that yeah I I intimidate them no yes it actually that

[00:25:54] [SPEAKER_00]: that works it gave me an idea at least I'm gonna move forward with the diagnostic stuff and if it

[00:25:58] [SPEAKER_00]: never comes to anything then whatever that's uh there's another patient that needed full mouth

[00:26:04] [SPEAKER_00]: extractions and um could have had two or four implants and I asked him what his budget was and

[00:26:10] [SPEAKER_00]: he said you know probably somewhere around 14 000 and I said okay we can probably make that work

[00:26:16] [SPEAKER_00]: and we did oh that I I'm amazed you've gotten I fit it into the I fit it into his budget uh that's

[00:26:25] [SPEAKER_03]: awesome whenever I I swear every time I ask that question I either get like well I kind of just

[00:26:30] [SPEAKER_03]: want to hear what my options are yeah or like oh man I've got I I've got like five grand saved up

[00:26:37] [SPEAKER_03]: for this yeah yeah okay that's not that's not even gonna really get us to like the

[00:26:44] [SPEAKER_03]: just the base base model of this denture you know so I mean I I I guess that's an answer

[00:26:51] [SPEAKER_03]: so I didn't get an answer right you know at least I knew where I was at but and I think a lot of it

[00:26:55] [SPEAKER_00]: is you know it's not your problem you're just there to present no I know and it and it is what

[00:27:00] [SPEAKER_00]: it is it's on you know it's just that's just what it is so um so it sounds to me like your

[00:27:10] [SPEAKER_03]: comfort level with dentures and full mouth extraction is considerably higher than mine because

[00:27:13] [SPEAKER_03]: if I serious if I see someone new patient who's just trashed out and upper lower completes of the

[00:27:20] [SPEAKER_03]: treatment plan my my first thought is that you know oh my gosh I think you probably want to go to

[00:27:25] [SPEAKER_03]: the denture clinic you know that it's down the road not not me you're you're embracing those

[00:27:31] [SPEAKER_00]: kinds of cases you're yeah and you know some of those will end up at the oral surgeon

[00:27:37] [SPEAKER_00]: and I'll just make the denture which you know whatever it helps the patient I guess that's not

[00:27:44] [SPEAKER_00]: the best scenario is I'm doing the extractions and the and making the denture and just keeping it

[00:27:48] [SPEAKER_00]: all in house but sometimes you can't based on their medical history and no factors and difficulty

[00:27:53] [SPEAKER_03]: because you can't but the money's not in the plastic it's almost always in the yeah yeah

[00:27:58] [SPEAKER_00]: so you know I'm I'm fully aware of that but you know meet the patient where they are and

[00:28:03] [SPEAKER_00]: if they need to go to the surgeon for whatever reason then that's where I'll go but

[00:28:09] [SPEAKER_00]: um I'm willing to make them a denture if that's the case but I understand what you're saying I would

[00:28:14] [SPEAKER_00]: certainly that's an option and I've certainly had patients come from the

[00:28:18] [SPEAKER_00]: denture mill to me and then probably go back when we see the cost and that's fine too yeah yep

[00:28:26] [SPEAKER_03]: you know uh cool cool um I still think that's tough I I I even you know I know that uh

[00:28:38] [SPEAKER_03]: Spears has the whole you know terminal dentition has the whole terminal dentition course which

[00:28:44] [SPEAKER_03]: I've I've viewed their their internet video on it it's still just uh it's still just a struggle

[00:28:51] [SPEAKER_00]: I think for me being at implant pathways and seeing you know on the full arch day

[00:28:58] [SPEAKER_00]: just seeing the level of dental disease and what they were willing I think that was a little bit

[00:29:06] [SPEAKER_00]: of an eye opener for me that I knew prior up prior to that I was starting to become

[00:29:14] [SPEAKER_00]: quote unquote more aggressive with just getting rid of stuff um that just cemented in in my mind

[00:29:22] [SPEAKER_03]: I I need to get more I need to I needed up my denture game so that I feel

[00:29:30] [SPEAKER_03]: that if uh I feel confident to say that like okay well if we're gonna if we're gonna take these

[00:29:35] [SPEAKER_03]: teeth out at least I've got at least I feel like we're gonna be able to give you something that's

[00:29:39] [SPEAKER_03]: a little more a little more reasonable so yeah yeah I get it that's that's next that's really

[00:29:46] [SPEAKER_03]: probably my greatest need of CE right now for sure Russell Schaefer what I'm looking I hope you're

[00:29:52] [SPEAKER_00]: listening really looking forward to is scanning someone and printing them a denture which the

[00:29:58] [SPEAKER_00]: scenario has are you getting there are you getting there I know you got the printer I would do it

[00:30:02] [SPEAKER_00]: tomorrow if they're right well the right person did walk in a couple weeks ago we just sure you

[00:30:06] [SPEAKER_00]: just didn't say yes yet so um I'm I'm waiting for that that's going to be fun it is coming

[00:30:14] [SPEAKER_03]: Kevin enjoyable talking to you as always uh hope you guys uh enjoyed just listening to us banter

[00:30:21] [SPEAKER_03]: rather than uh some guests for the last couple weeks but we will we'll get some guests back

[00:30:25] [SPEAKER_03]: if they don't stand us up you know we'll we'll we'll get them back on yeah and um you know

[00:30:32] [SPEAKER_00]: that's this is a I think this this discussion could be expanded by some other you know guests

[00:30:42] [SPEAKER_03]: it could be it absolutely could be we could uh so if you have a suggestion for a guest for us

[00:30:48] [SPEAKER_03]: or if you'd like to be a guest uh let us know on the very clinical facebook page also have

[00:30:54] [SPEAKER_00]: enjoyed if you want to be a guest first of all don't stand us up and second of all um you have

[00:31:02] [SPEAKER_00]: to write us a check um you know in the neighborhood of $500 to be a guest that's $500 for each of

[00:31:10] [SPEAKER_00]: us so yes a thousand a thousand dollars you can be a guest on our podcast and um the whole world

[00:31:16] [SPEAKER_00]: can hear your opinions on teeth and gums and um dentures what a bargain yeah what a bargain for

[00:31:24] [SPEAKER_03]: 30 minutes of time yeah what a bargain all right Kevin uh I love we will catch you listeners

[00:31:33] [SPEAKER_03]: next week