Very Dental Student: How to Do a Comprehensive Exam with Zach and Kevin

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[00:01:27] It's time for a Very Dental Podcast just for students and new dentists. Welcome to the Very Dental Student Podcast. And now here's your host, Mohamed Aboubasha. Hello, everybody. Welcome to another episode of the Very Dental Student Podcast. I'm your host, Mohamed Aboubasha. And I'm coming at you guys again with my favorite co-hosts, Kevin and Zach. Kevin and Zach, how are you guys doing? We're great. How are you, Zach?

[00:01:56] I am good. Yeah, everything's cool. Are you any warmer than you were a half hour ago? I'm definitely warmer. Yes. Yes, I am. Thank you for asking, Kevin. It's probably warmer when this comes out because it's pretty cold here. It sucks. There's a Super Bowl coming. When is the Super Bowl? Sunday, Sunday, Sunday. Sunday what? What's the exact date? The night. The night? Okay. I'm assuming this is coming out on the 4th? Before February 9th. Okay.

[00:02:25] I guess, yeah, Sunday the February 9th. I guess I don't know when else. So Zach loves the Super Bowl because his Chiefs always cheat and get into it somehow. Yes. Yes, it's the cheating part that I embrace. Totally a joke. Okay. You're not cheating. You're not trying. But I'm only going to watch it for the commercials, which I hate when people say that. And the halftime show, which I'm probably not going to watch. No, you're not going to enjoy this year's halftime show. Who is it? Are you a big fan of Kendrick Lamar? No, I'm not. Are you a big fan? No, I'm not.

[00:02:52] You seem like a big fan. Muhammad, are you a big fan? Kendrick Lamar, is that your jam? Kendrick Lamar. When I did listen to music in high school, I did listen to Kendrick Lamar. Okay, well, there you go. You're going to enjoy it. I wasn't like a big fan. He had just dropped some album and everybody's listening to it. I know who Kendrick Lamar is, but I got to be honest, I can't name one of his songs. I do know who he is, even at my ripe age of 61. Okay. Well, that's great. But I don't know his songs.

[00:03:23] Which song is called Be Humble? Be Humble. That was the big one. Be Humble? Okay. That was very popular my senior year of high school. I'm the best to be humble. Well, there you go. So, see, I was super pumped about this halftime show. He's jacked. Excited. It might even be my dream halftime show. Well, I have a dream halftime show. Okay. So, here's my dream halftime show, and it has to happen soon because time's ticking. It would be Weird Al Yankovic.

[00:03:54] And what's going to make it special is that the Weird Al Yankovic parody songs would be joined by the actual performers. Oh, wow. That's way better than any idea. Wow. I wish he wouldn't have gone first because that's a way better idea than anything I could have possibly come up with. So, okay. Let's say there's some sort of Kendrick Lamar song that Weird Al Yankovic parody.

[00:04:23] Then Kendrick comes out and joins him. And then, like, he gets, you know, taken off stage. And then, you know. And the next person comes up? Yeah, it's Beyonce or someone. Right. I love this idea. I want this idea to happen just, like, in a music video format or something like that. That's awesome. He's getting up there. He's kind of, how old is Weird Al? He's got to be late 60s, early 70s. Have you ever seen him in concert? He's coming to Kansas City this summer. I've never seen him.

[00:04:51] I'm trying to get my kids pumped up to go, but they're not buying it. Yeah. Have you seen him? I've never seen him. You've never seen him? A fan of that genre of music, Mohamed? To be honest, I don't know. You don't know who Weird Al is? Whoa. Wow. Okay. Yikes. But, I mean, bear in mind, I don't listen to music. But that's... Okay. Bet. So, forever.

[00:05:19] So, your ideal halftime show would be, you know, some dead air. Yeah. Right. More commercials? Maybe a skit. My ideal halftime show would be anything that would, you know, bring in an artist from Egypt. That would make me feel awesome. Who's a big Egypt artist? There's a couple right now.

[00:05:47] I mean, there's a guy named Tamar Husni. He's very famous in the Middle East in general. There's a new guy, like a little rapper. His name is Wiggs. I don't listen to any of them. But just the fact that they're from Egypt would be pretty cool. But it would never happen. No. That's probably not going to happen. Because all the American fans would be like, what's happening right now? Weird Al is 65. 65. Okay.

[00:06:14] So, he's just a few years older than I am, interestingly enough. All right, Zach. Who's your... Who's your... Okay. So, well, you know what? Since your music idea beat the crap out of mine, you know what I'm going to say? How about a different format? Yes. And after Muhammad said no music, how about a different format for the halftime show? Yeah. A play. How about a comedy crew? How about like, you know, a couple big performers? Can you just come on? A couple fast fives from like a couple big names. Comedy show. Boom. Bring in Phil Bird.

[00:06:44] Nate Bargatze. You know, like just bring them in. You know, a tight five to seven. Some hot jokes. And, you know, maybe a few fireworks in the background or something like that. And then just boom. That's your halftime show. Comedy. Let's make it fun. Comedy. I dig it. That's my halftime show. I like it. Excellent. Perfect. That's not going to happen either. No. It's all about the big spectacle. Yeah. And all that.

[00:07:12] The Super Bowl I got to attend was the J-Lo and. No, I'm sorry. Yeah. J-Lo and Shakira. It was the halftime show I saw. Let me tell you the process. Oh, I bet. The grounds crew goes through to throw together that stage in minutes. So that, like, you know, they have a couple minutes of football chat and then boom is a really elaborate show.

[00:07:38] And then to break it down was one of the most fascinating things I've ever witnessed. Just from like a construction mindset. What if that's the halftime show? We just see them build the stage and take it down. No one performs. Let me tell you, they don't show that on TV. I know. And I thought that I thought that was cool as hell. Yeah. I really did. I was like, wow, that is. I never thought. They built the stage. That was awesome. An entertainer performs for one minute and then they take the stage away. That's that's the show. Let me tell you.

[00:08:08] And we see it all. Those stage builders are the real MVPs. Or actually, it's like a magician. Really? You can have them. Instead of comedians, we can have a magician. We'll make Terry Bradshaw disappear. That sounds great. That sounds great to me. So, yes. I would love that. I will take that. Yes. Wonderful. All right. There it is. Awesome. Yeah.

[00:08:33] We'll all be pulling for Zach's team in the Super Bowl. You don't have to. It's OK. You really don't have to. We've already won a bunch. No one's rooting for the Chiefs except for Taylor Swift fans in Kansas City. At this point. We're now the hated team. I'm rooting for the Chiefs because I want my homes to go down as the great. Just because I don't. Oh, you want him to beat out Brady. OK. I don't like Tom Brady. I don't know why. Just the way. Something about him. That's fine. I don't like him either.

[00:09:02] But, you know, it's fine. It's cool. Yeah. All right. So on that note, we'll jump straight into our topic of the day, which is how we do comprehensive exams. This is something I'm actually really interested in knowing because I hate the way our school does it. So. All right. Let's hear that. You go first. It's just such a process. Yeah. It's so long. That's what that's what really makes me.

[00:09:29] I remember exams in school also being long and super sucky. And that being one of the biggest changes of everything I did from school to, you know, private practice and it being a hard switch to make. Yeah. So go ahead. Yeah. For us. So. So the first time you see a patient is not even part of the of the comprehensive exam. It's just screening. And that's a one and a half hour appointment where you're just screening them.

[00:09:59] And so. Are you pushing them through a screen door? What is your screening process? This is just to essentially decide if they can be a patient in the student program. Okay. Whatever. So. So we do. We go over a short medical history and a short dental history. And then we go down. If we go take bite wings and a pano, which is in a different, a different floor.

[00:10:28] So we have to go down to a different floor, get by wings and a pano come up. And then we kind of do a really quick and dirty probe just to see where we think the deepest pocket is. And we measure that in each quadrant, deepest quadrant or deepest pocket of each quadrant. And then we go tooth by tooth and guess what the what the tooth needs without actually coming to a diagnosis. So you're like, oh, this tooth probably needs a filling.

[00:10:57] This tooth probably needs a crown. This tooth probably needs whatever extracted. But you put this all down into the into the screening form. And then the faculty comes over. You discuss with the faculty your findings. You between the two of you decide if this is something if the patient's expectations and how difficult the case would be is appropriate for a student student program.

[00:11:25] Are you scouting for your your own patient library? Or is this just like is that just part of it? Like screening is one of the jobs. And then you just narrow down the patients. And then here's a big stack of charts that end up getting dispersed to people. Are you screening? Is this for you or for your school? Your class? It depends how your faculty wants to do it. So for us, if we want the patient, we keep them.

[00:11:52] So but if we don't want them, they go into this pool. This is like some terrible choosing sides for a pickup basketball game. And you get chosen last. The poor patient. Nobody wants you. Yeah. So for like. Yeah. So that's kind of the process for us. But other other other group practice direction directors don't let people keep their patient per se.

[00:12:18] And they want to be the one assigning everything to make sure that everybody's on the right track. OK. So it depends. But so let's say that the patient gets accepted into the program. Can I wait a minute? Can I interrupt you? What are the like automatic like now? You're gone, bro.

[00:12:39] So if we have to change the video, like if it's basically a full mouth rehab, then we won't do that at the student program. That's a lot to pick up and figure out, I feel like, as a new student. But, you know, that's fine. I get it. Keep going. I mean, we look, but the faculty really knows. OK, sure they do.

[00:13:01] And then other things is just like patient indicates several times that they don't have the finances to really get the treatment they need. Like if so, like that's if they're really obviously not going to be able to pay for the treatment because then that's kind of a waste of time for the student. And then if the patient's expectations or if the patient's just kind of crazy, like sometimes you can tell, I guess, in a screening.

[00:13:32] So can you come screen? Can you come screen my patients? Yeah. Can you get rid of anyone that has any of those problems, too? I would love to take care of the, you know, hyper difficult, broke, and unrealistic people, too. That's great, man. And yes, you shouldn't you shouldn't hate this process at all. This is wonderful. Yeah. Kevin, I need this. What do you need this? Sure. I want to get rid of the crazies. Yeah, that's right. Yeah. OK, cool.

[00:14:02] That's that's theoretically in theory. That's what it's for. But I mean, a lot of a lot of the patients slip through the cracks for sure. OK. Like, I'm loving it so far. Keep going. So so let's assume, like, they've been accepted to the program. All right. And we're we're going to they're going to not leave with an appointment because they still have to officially be assigned to a student. Yep.

[00:14:26] So then once they're officially assigned to a student, they come in for the first appointment and you go through a much longer medical history and a much longer dental history, including asking questions about like, oh, your father's dead. How did he die? Things like that, which I don't know why that's in our forms. And then a lot of fathers die of class two carries.

[00:14:54] Yeah, that's what it is. Yeah, it is. It's from not using the EDTA on those root connect. Yeah, that's that was that was the cause of death. It's because they only got one carpool used on their crown prep. Kill them. They died from crown anxiety. Yeah. Yeah. So so and then we also have like.

[00:15:25] I mean, we have patients that a lot of the patients have longer medical histories. And unfortunately, there's like if somebody has something, a diagnosis and a medication, there's like at least three places where I have to notate that. So just it just takes longer in general. And then we do. FMX usually. So which involves going back down to radiology, which after you've got the panel and bite wings, then you're doubling down. Yeah.

[00:15:56] If they need if they need like more dentistry, you then you have to go get an FMX. Like unless they just a very simple case. But if they if they're going to need a couple crowns or an endo somewhere, then now you have to go get an FMX, which you've already been down there. And anyway, so then that's that process takes a while as well. Getting the FMX and then coming back up to clinic.

[00:16:23] And then you have to go through the odonogram, chart everything that you chart all your findings. And then there's like you do the perio chart and then you there's a diagnostic findings form that we fill out that has a tab for everything. So we have a caries risk assessment, periodontal diagnostic findings on extra oral, intraoral examination, cancer screening form that we fill out.

[00:16:52] So it's not like it's not like you can just say no significant findings like you have to fill out. It's like you have to fill out each question, even if you're going to say no, like you have to go question by question. How many death by boredom has a patient's experience during this exam process? Is that a cause of death? But I wouldn't be surprised. Yeah. And there's an occlusal questionnaire.

[00:17:23] Yeah, there's just a lot that we have. I'm probably even leaving some of it out. And yeah, this is along with getting permission to start at the beginning of the appointment, waiting to do that. Consent. Getting an alginate or getting alginate impressions at some point during this and a face bow. And yeah, so there's a lot of stuff. So the workup actually usually takes two, three hour appointments. Excellent.

[00:17:53] And that includes... That's exactly, this is exactly how Kevin does it. Yeah. This is how we... This is what he teaches. So that's great. There's no difference. All right. So we do that. And then we usually try to fit in whatever consultations we have. Oh, the dreaded like endoconsult, the prost consult, perioconsult. Luckily, endoconsult doesn't have to happen with the patient in the chair. We just need a PA. Oh, okay.

[00:18:20] But like if we need to do... We need to do definitely a perioconsult, operative consult, and fixed consult. If there's any fixed. Right. Yeah. All right. Back to start. All right. Be back. So Kevin, you're teaching a course on this soon. So why don't you clean that up a little bit here?

[00:18:49] Well, I'm going to approach it from a little different aspect. And I know that this is not feasible at school. And part of what you've talked about, Mohamed, I do think if you are learning that some of that is good. Two, three hour appointments just to get to that is insane. But checking all the boxes at first or whatever, I don't think is a bad idea.

[00:19:18] But from my standpoint, in terms of records, I want to... And 99% of this is going to be done by a hygienist or an assistant. This is not... I'm not doing any of this. I'm coming in at the end. But the record's taking.

[00:19:40] If you're a new patient, we're going to start off with medical history, of course. And then we're going to take six photographs. We're going to take a... Actually, I take that back. We're going to take nine photographs. We're going to take a smile shot, retracted smile shot, upper occlusal, lower occlusal.

[00:20:10] Right and left buckle. This may be more than nine. And then we're going to take some ortho shots of their profile and silhouette and all that. Because... Let's just stop there for a second. I want to be able to explain everything that I'm seeing to the patient. And the best way I can do that is to show them. So I have giant monitors in all my operatories.

[00:20:39] So if I show you your upper occlusal photograph, Muhammad, and you and I both can see that the mesial buccal cusp of number 14 is broken off, even though the patient might feel like something doesn't feel right here, we both can see that. But when I say that tooth needs a crown, I get... You know, the patient can see that.

[00:21:05] Otherwise, it's very difficult to convey that information to them. But the photographs, to me, are the most important thing that we do in that period of time. After that, after the photographs are done, they're going to go get a cone beam because I want a three-dimensional representation of their dentition. The panorex is...

[00:21:34] I'm going to say useless, but there is some use to it. But I would rather have the cone beam than anything else. Then we're going to get four bite wings, maybe some PAs of the anteriors. And then what I would like to do, and this isn't always done, but what I would like to start doing

[00:21:58] is digitizing the patient by taking a prime scan of their teeth. So I have a digital record. That's your alginate impression. I want to digitize my patient as much as possible. And from there, we can, you know, the perioprobing and the recording of the existing conditions, that's going to be done by a hygienist.

[00:22:26] But the most useful thing for me is the photos and x-rays. And very often, for a new patient visit, I'll be sitting in my office just looking at the photos and the x-rays, and I already know what the diagnosis and treatment plan is going to be without even looking inside the patient's mouth. Yeah, 90% of the time. That's powerful to be able to walk in, you know, with a pretty good idea of what's up.

[00:22:52] And then since we're, you know, heavy Invisalign office, having those photographs, you know, let's say everything's fine. But, you know, you have some crowding in the lower interior, or you just don't like the way your teeth look. I have all those records right there. I don't have to go back and take them. I can show, you know, a part of the exam is showing them their retracted smile and just simply saying, are you happy with your smile?

[00:23:22] Because that's a yes or no question. Are you happy with your smile? Yes. Great. Great to meet you. Thanks for coming in. We'll see you again in six months. No. Okay. What don't you like about your smile? I don't like the way this tooth overlaps this tooth. I don't like, you know, the spacing here. Okay. Let's start talking about some cosmetic concerns. So, but it all starts with the photos.

[00:23:50] In fact, we have a lot of technology in our office, but our digital camera is the most important piece of technology in the whole office. I used to think it was the phone, the telephone, but I've amended that to the camera. Yeah. So that's how we do it. The camera is real, real important to have, to have in your hygiene department as well as in your exam rooms.

[00:24:17] Also, all of the, these recording, recording of the current condition, I've done that with a photo. I don't have to really write anything down. We've gotten away from that. Like there's a photo here. We're going to keep that forever in the patient's chart. I can tell you that you had an OL on number three when I met you. Amalgam or whatever it is. So anyway, it's, that's, if, if anything,

[00:24:47] that is the most important thing is the photos. It's also nice when then someone, you know, says something down the road, you know, something's changed with this or that. And you got that photo to be like, nah, you know, I mean, it's just, it's nice to, it's nice to have those things, that documentation to be able to just, you know, fix things, fix that conversation real fast. That's super nice to have. I regret it when we, when we don't get it.

[00:25:16] It saved my butt in more than once. I believe it. Yeah. Same. You broke this tooth. No, this is what we took this photo when you first came in and I can flash the date on it. You know, you, you came in on two 11, 2019. This is what you looked like then. And this is what you look like now. Yeah. Yeah. That's good to know. We've definitely had, um, a faculty,

[00:25:45] one of our faculty really encouraged this, um, like taking a full set of, uh, you know, DSLR photos and, um, and putting them up on the screen for the patient to see and everything. The, the only issue is with, you know, I don't know that it would be possible in, in a dental school environment, but if, if, uh, Zach and I became D co-deans of your dental school and we could figure out a

[00:26:14] way to have that happen, that's what we would do. I mean, it could be as simple as using your iPhone. So something. Sure. You know, it doesn't have to be, it doesn't have to be the best photo. It just doesn't be a nice, you know, fog free clear photo. Yeah. We do have DSLR cameras for that. We can check out, but everybody's like, well, I don't have time because I don't blame them. I don't blame you for that. And also having to do all the stuff with the mirrors and all that, that's a,

[00:26:44] it's sometimes a multi-person job. It's a process. And, you know, again, delegating that I don't do any, I don't know the last time I've taken, well, I take photos for stuff that are going to end up in lectures, but for a new patient, I don't, I'm going to walk in the room after all that stuff's done. That's what I delegate to my team members. That's smooth. That's smooth. That's the way it should be done. So, so then moving,

[00:27:13] moving on to like what the rest of the appointment looks like once you have all the records and like, what does the, what is your workflow past that? Like when, once you sit down, like what, what are you doing? You're going over the photos first. All right. So typically, typically a patient will have had their teeth cleaned in this interim time because that's a lot of times. That's what they've come for to have their teeth cleaned. And I don't care if they, I don't want to get into the weeds on this,

[00:27:43] but I don't really care if they have perio at this point, we're going to treat it, but people want their teeth cleaned. I have a business to run. I have a reputation in the community to uphold. So that's a whole nother discussion, but let's just say, we've taken all of our records. Patient has had their teeth cleaned. My hygienist has talked to them. Oh, by the way, there's an intake form of that has questions like, what are you here for?

[00:28:13] Like, I don't like my smile. I have a toothache. I have a broken tooth. I have, I'm fearful of going to the dentist. You know, these are all things that we can use as a team, you know, to help build your treatment. But anyway, I'll come in, introduce myself, make a really dumb joke, you know, create some rapport and trust very quickly. And then I'll do an exam,

[00:28:41] which at this point is fairly cursory because I've already looked at their photos. I've already done the exam. This is just, I kind of have to do it. And then I will, my routine is to start with their bite wings. Um, go through and explain what I'm looking at. We have, uh, overjet AI. So it's, it's even easier to explain that. I'll explain what I'm looking at. Then I'll go to their cone beam,

[00:29:11] pop that up and go through a very efficient exam of their cone beam, but show them that they're seeing all, all the slices and everything. And then the last thing I do is go through their photos. And what I usually do is put their upper occlusal shot up first and say something like, these are your upper teeth. You don't get to see this view ever. We see it all the time. This tooth on the upper right.

[00:29:40] That's the one you've been complaining about. That's chipped or broken or hurting you. This is why this filling is broken or it's cracked or, you know, whatever they, their chief complaint was, I'm just going to expound on that while they're actually seeing what it is in front of them. I'll go through the upper occlusal first. I'll go through the lower occlusal first. And then I end up on their retracted smile shot. Are you happy with your smile? Yes or no? Yes. I'm going down one path. No,

[00:30:09] I'm going down another path. And then we come up with a treatment plan and a financial person comes in and gets that all wrapped up. And then we get them scheduled for whatever it is. Smooth. Smooth. Very good. But it's relying on highly trained, efficient team members that I've delegated a whole lot of stuff to and spend a lot of time coaching them. Yeah.

[00:30:40] Yeah. I mean, yeah, definitely sounds like a really good workflow. I'll definitely have to listen back to this once I'm actually setting up. Yeah. And if you end up associating, you're going to end up, you know, probably having to do things. Yes. The way, you know, the office has it set up. And a lot of, a lot of new patients go through hygiene, which I know Kevin described something similar,

[00:31:07] but without that much workflow. And so there's, you know, you'll have to, you'll have to listen to this and then take what you can do in, you know, in the confines of whatever work environment you get yourself into. Cause there's a lot of different business models and ways, ways of doing it. And, you know, you'll, you'll find some kind of a happy medium, but just the,

[00:31:30] the takeaway is photos are excellent for patient education. Good patient education. Certainly assists with the advancement of getting a treatment plan in motion for you, which gets your work on your, on your schedule. You know, that that's really the real takeaway there. Sure. And the photos are more important than things like a perio chart in a lot of cases, or, uh, you know,

[00:32:00] some of those things. I mean, those, I'm not saying a pair of just aren't important, but the photos mean more to the patient in terms of your communication than a chart. And also, I, I'll add this using patient friendly language. I never, I never, I long time ago got away from saying big doctor words. You know, you have a broken tooth, a tooth like this needs a crown. Very simple. Two sentences. And if they ask me something about it,

[00:32:30] I'll answer, but I'm also going to try to answer that. So I don't know if you've ever had this experience, but I'm not a mechanic. I take my car in and the guy is telling me about the R40. carburetor on my, what's a McCall it, Franklin spanner works. Like, I don't know what you're talking about. Explain it to me like I'm five.

[00:32:56] Like once you have an expertise in a subject matter, which you will have Muhammad, but your patients do not have that. They need to be spoken to in very plain language. That anyone can understand. Your tooth is broken. It needs a crown. Your tooth has a cavity. It needs a filling. Your teeth, your tooth is broken to the point where it can't be fixed. We need to remove it. We need to extract it.

[00:33:28] So, yeah, very valuable. Pro tips for sure. Pro tips for sure. Yeah, definitely. Any, any other things to add or subtract Zach from all of them? I wouldn't subtract anything from the way Kevin did it. If anything, I need to add more of, of what he does into, into what I do. Um, I mean, if I was going to say something different, it would be that, uh, you know,

[00:33:57] depending on the type of patient population, yourself, you get yourself into, if you're seeing a lot of like teens or 20 somethings or something like that, well, you know, alter your times, alter your stuff because the odds are that they're going to have anything more than operative stuff for you to do is, is, is low. And so, you know, or if someone calls up and, uh, you know,

[00:34:27] I was, I've just moved to town, but I was done six months ago. Um, and I'm, you know, and your staff's good enough on the phones, you know, I don't have any concerns about it. Well, you know, know that you're not going to need maybe all of this, all of that stuff because they're probably coming in as a low need. Some, some phone triage can help your exam planning process too, for sure. Because we, I remember when I started, I started at dad's that, you know, we had some longer exam periods, um,

[00:34:57] set up for dad to do, you know, a set of records in the, you know, early O's, which did include still allogenets and, you know, we didn't have as good a photo, photo work and stuff like that. And then I got a bunch of teens and it was like, well, there's nothing, there's not, there's, there's like five minutes of work here to do, not an hour's worth of work. So I, you know, sometimes you have to tailor it a little bit to who you're, who you're seeing. I think that makes a difference. You know, there's a difference between the 60 year old person who's coming in, who hasn't been to the dentist in a while. And the, you know,

[00:35:27] 19 year old who was in six months ago, you know, I don't know. Maybe Kevin can, that's a different point of view, but that's just been my perspective. What I would add to that along the lines with Zach, there are some patients that will call and say, I haven't been in the dentist in a long time. I know I need a lot of work, uh, or I know I need dentures or I, I I'm interested in implants. And those end up on my schedule in the doctor's schedule. Cause it's going to take more time as opposed to going through hygiene.

[00:35:57] Yeah. Cause there is no hygiene to do. Right. Correct. And occasionally, most of the time we, um, triage those people. Right. And they end up in my schedule. Occasionally they don't. And I get this look from the hygienist. Like, what am I supposed to do? Like, just call me in and we will talk about, we're going to be making you dentures or whatever it is. Every, every once in a while you're going to get, you know, someone in their low twenties. It's like a scaling and root planning bomb, a disaster. And you,

[00:36:26] when it didn't get triaged, And they're in for like a, you know, a regular probe time. And that's, that's just the way business, you know, there's going to be some, there's going to be some things that don't work out totally. Real life, you know, for the most part, we've got things dialed in, but real life, you know, stuff happens. But yes, you know, certainly dialing in your phone crew to be able to, to triage some of those people. You know, from, is this an emergency visit? Is this a, you know, is this actually that some of those things help out a lot. Also,

[00:36:57] like we do get a fair amount of emergencies that are extraction patients that in my view, those are tooth replacement therapy patients. They're going to get extraction graft. We're going to have them back for a new patient comprehensive exam. After we take care of their immediate problem. You know, in terms of Zach, Alan and I had a conversation earlier today about servicing your community. That was one of the things that was brought up. Yeah.

[00:37:26] Someone calls with a toothache and you take care of them. You know, I, all this, we're still going to take the cone beam. We're still going to take all the photos and everything. We're just not going to have the global conversation. Your lower molar is broken beyond what we can fix. We need to take that out today. That's why it's been hurting you. We'll take that out. We'll graft it today. Uh, and then we're going to have you back because I've noticed some other things that are going on too. We'll come up with a more comprehensive plan for you. Does that sound okay? Yes,

[00:37:56] please. This tooth has been killing me. Can we take care of it today? Or, or you'll get the, the, the person who's, you know, indentulating themselves one tooth at a time. And in that case, they'll be like, ah, no, I'll see you in the next toothache is. Yeah. And it's nice to be able to figure those people out who they are. So it's, it's not one size fits all. There, there has to be some sort of, um, pivoting. When you need to, but, um, you know, works for us. Absolutely. Yeah. Perfect. Yes.

[00:38:25] That is a definite difference though. I think between private practice schools, you're going to get the like emergency based calls a lot and, and, and have to adapt to being like, wait, this isn't a global tooth conversation. This is a, those are great patients. I love it. You know, they are, they are sometimes a lot of times, you get a lot of endos that way. You get a lot of extraction. You do. A lot of implants come out of that. Yep. Perfect. Super.

[00:38:55] I definitely appreciate you guys making this more concrete, uh, for me and the students listening. Um, yeah. For any of the students, if they have questions or anything like that, feel free to send me a message. Um, but, uh, for now, we'll see you guys next time. See ya. See ya.