Very Dental: Treating the Disease, Not Just the Tooth with Dr. Josh Solomon

[00:00:01] [SPEAKER_01] This is a production of the The Very Dental Podcast Network. This is the Very Dental Podcast. Welcome to the Very Dental Podcast, where you'll find entertaining and relevant conversations with visionaries, clinicians, and your friends in the dental space. Now here's your host, Dr. Alan Mead.

[00:00:29] [SPEAKER_01] Very Dental people, welcome to another episode of the Very Dental Podcast coming to you from Scottsdale, Arizona, the BioClear Summit 2026. We just wrapped it up. They just finished it up. I've had a chance to listen to a lot of speakers, did a live podcast, and one of the guests on the live podcast that you'll be hearing at some point, Dr. Josh Solomon. Josh, how are you doing?

[00:00:49] [SPEAKER_02] I am well. Thanks for doing this. I appreciate you being here.

[00:00:52] [SPEAKER_01] So Josh and I have known each other online for a while. Actually, I mean, I've known you from BioClear stuff, also microscope stuff. Correct. We both have the distinction of spending probably too much money and time on microscopes.

[00:01:12] [SPEAKER_02] Yeah, yeah. And everybody that has microscopes likes to talk about microscopes.

[00:01:15] [SPEAKER_01] Yeah. Oh, yeah. It's a pathology, to be perfectly honest. I think it's probably diagnosable. There might be a code for it. Probably. And of course, there's a new microscope manufacturer that showed up here that I looked at. Josh, luckily, didn't look at it. So good on you. I did that on purpose.

[00:01:30] [SPEAKER_01] Yeah, I mean, that's good on you. I was avoiding it because the Enova Illumination guys were right across the hall, and I was like, okay, I've got Enova Illumination. It's really good. I'm kind of excited about it, to be perfectly honest. I need another scope like I need it. But you always need it. Really and truly, you always need it. You do.

[00:01:46] [SPEAKER_02] You know, the thing is, it's one of those, it's almost like your third eye. We were talking about this earlier. Your third eye gets open when you, and it's not one of those things saying, oh, I've got a microscope. I'm this fancy restorative dentist.

[00:01:59] [SPEAKER_02] No, it's just when you could actually see that distinction between carious enamel as it gets to the dent, and you see it peeling off, you just understand more, right? And I wish more dentists would go up in magnification because I think you can just do better work and you can see things, right? Yeah. And when, you know, when we both went to dental school and you know, amalgam, you could have a river of blood, it doesn't matter. You can just pack a bunch of metal in there, right? Hell yeah.

[00:02:28] [SPEAKER_01] You can't do that anymore. Yeah. I mean, you could if you wanted to. Right. But the amalgam thing is so funny because I remember, God, early, 2002, Dentaltown. Like, all it was was the amalgam versus composite wars and how.

[00:02:42] [SPEAKER_00] Right.

[00:02:42] [SPEAKER_01] And what's funny is I know I was doing amalgam back then, and it was fine. I haven't probably placed in amalgam for, it's been a while. I'm not even against it. I think amalgam has saved a lot of teeth over the years. Like, there's a lot of teeth that it saved over the years. And for what it was, it was pretty good. But I do laugh a little bit because, like with the magnification, it's like when you know more, you know more. You know?

[00:03:08] [SPEAKER_01] It's like a, so, and it clearly, like I said, a lot of people hung on to a lot of teeth because of amalgam. So, you know, it sure doesn't know us anything that way. But it is interesting, you know, I was telling yesterday, one of the weirdest things in the microscope is how human gums under high magnification look different and they move differently. Right.

[00:03:29] [SPEAKER_01] They literally move differently under high magnification. They're not moving differently since you can see that they move differently. You can see the attachment is different. All the things you can see. And I never knew that. I never knew that.

[00:03:40] [SPEAKER_02] You know, and I think what happens too, when you go up in magnification, you realize how much I left behind. Yeah. Right? Yeah. Like, you would have what I thought if I was using three power. And again, I don't want people to think you can't do good dentistry without, you know, you have to have a microscope. Yep. But for me, you know, if I'm teaching a doctor, I really want to be four and above. I found that's really that sweet spot.

[00:04:06] [SPEAKER_02] And the thing is now is there's some manufacturers that are making pretty amazing, even ergo loops.

[00:04:12] [SPEAKER_00] Yeah.

[00:04:12] [SPEAKER_02] You know, there's one that's going to come to market. I can't talk about it just yet, but it's an ergo loop that is three, five, and seven adjustable.

[00:04:20] [SPEAKER_00] Yeah.

[00:04:21] [SPEAKER_02] And that's going to be amazing because, you know, when you're in the interior, you don't want too much magnification. Yeah. Yeah. But when you can go to click, click and get to seven with a really good light, you know, the work that we all do, most of our materials are, you know, they're sensitive to light, but they're even more sensitive to blood. Yeah. And cavicular fluid. And fruit by the foot and everything else that's in these teeth.

[00:04:42] [SPEAKER_01] You got a lot of hate for that fruit by the foot.

[00:04:44] [SPEAKER_02] Well, as a pediatric dentist, I see a lot of children where the parents say they don't eat any sweets at all and they come in with jujubes and fruit by the foot.

[00:04:51] [SPEAKER_01] Fruit by the foot, delicious. Not great for your teeth. It's not. Yeah. It's not. Yeah. That's very true. Yeah. Maybe the bane of a pediatric dentist's existence, really. You know, what happens- Did I mention that you're a pediatric dentist, by the way? No, we didn't talk about that. Yeah. I mean, like, look at this. We're 10 minutes into this thing and we haven't even dropped the whole pediatric. Because I have to say, we've not had a lot of pediatric dentists on the podcast and that's not because I didn't want them. I don't run into them very often. You know, they're so busy in surgery. They're so busy in the OR. They're so- I don't know if that's really true.

[00:05:21] [SPEAKER_02] No, it is. I mean, that's- It's just like, you know, when someone asked me who wasn't a dentist what a prosthodontist was. And I said, well, they get all the hard stuff. Yeah. They're like a regular dentist. They just get the hard stuff. Yeah. But, you know, for as a pediatric dentist, I don't listen to cry. You just don't hear it anymore, right? We just do it. But I cry a lot too, though.

[00:05:45] [SPEAKER_01] So that would feel kind of normal. That would feel like, okay, I got this. I got this. Yeah.

[00:05:50] [SPEAKER_02] But, you know, when I teach some courses to general dentists, what I really, I think it's important for them to know is so much of, you know, what we're doing in peds is really training the parent as much as you are the child. Yeah. Right? Because there's no five-year-old or six-year-old or 14-year-old boy that's actually going to do a good job with their teeth. And so it's frustrating. You know, we see these kids with just rampant class two care. That's like, ugh. Right? Yeah.

[00:06:19] [SPEAKER_02] And it's stressful for a lot of dentists, you know, for class twos. And insurance reimbursements have gone down. Yeah. And, you know, they're getting paid if they're in a PPO-style practice. They're getting $130 for restoration that actually I think is really difficult to often do a good job with.

[00:06:35] [SPEAKER_01] Like as hard to do as anything. Correct. Not the lead. I mean, the dentistry in and of itself is hard enough. And then you've got behavioral, you know, patient management issues that are kind of next level. Then, you know, general dentists can bitch about their patients that say, yes. But for the most part, you know, you can, they'll shut up and open their mouth enough for you to get in there and do the job. Where it's like, I mean, no offense, but for a lot of kids, trying to negotiate with a kid is like, I think I might have a better shot with trying to tell my cat to open wide. Exactly.

[00:07:05] [SPEAKER_01] It's like, yeah.

[00:07:06] [SPEAKER_02] You know, if there's one thing, if there's general dentists listening, when I started using, you know, AI-assisted care detection and looking at a device like a diagonal camera, you use transillumination. And you can see, physically see between the teeth. I had to do a little bit of a reset on how I treatment planned. Yeah. Yeah.

[00:07:29] [SPEAKER_02] Because I remember I saw, it was one of the Facebook groups and someone had posted a treatment plan they saw for a patient. It was second opinion. I think they had cured treatment planned on maybe, I don't know, 10 teeth. Okay. And people were saying, oh, this is awful. This is awful. You know, they're highway robbery. And I'm thinking, and they posted the radiographs and they were all just E1 lesions. And I was thinking, thank goodness, you know, they're getting in there that early and doing something about it.

[00:07:56] [SPEAKER_02] Because one of the concepts I like to teach is burr versus brush.

[00:08:00] [SPEAKER_00] Yeah.

[00:08:00] [SPEAKER_02] Right. You want to take a burr to something or do you want to just, it's a chemotherapeutic treatment versus a surgical treatment. Yeah. Right. Yeah. So I think what happens is in dentistry, sometimes we don't want to overtreat them. Yeah. No, for sure. Yeah. And so you see these little lesions in the enamel and you think, well, we're going to watch them. I used to watch a lot more teeth. And the longer I practiced, what I found is just getting the family on board, supervising.

[00:08:29] [SPEAKER_02] So one of my favorite things to do is we just have these calendars that has four spots per day. Brush, brush, floss, mouthwash. Brush and we make the child in charge of it. Right. So, you know, seven-year-old, we give them the calendar and we say, okay, your job is to check off that calendar, bring it to your parents, get help. And little things like that can make a big difference because I don't want my patients coming to you and needing root canals and crowns and bridges and all this stuff. We're the first day.

[00:08:52] [SPEAKER_01] So you give them a calendar. They're doing this once they're checking the boxes off once a day.

[00:08:55] [SPEAKER_02] So there's four spots per day. Brush, brush, floss, and then mouthwash. Yeah. If you use a mouthwash. That's right.

[00:09:01] [SPEAKER_01] First off, pediatric, that's amazing. I don't think my kids don't know what floss is. Right. But almost all the lesions that I see are interproximal. If they do check that off and like they get the month's worth, do you give them fruit by the foot?

[00:09:14] [SPEAKER_02] You don't give them fruit by the foot. We do ask them to come back. We have like special prizes or, but you know, parents are busy, especially these days. A lot of parents, they, or they may be a single mom that has three kids. There's no way I can barely take care of myself. I don't know how my single moms that have two or three children work full time and they take care of Kilt. Yeah. And I also want those children, especially if they're high caries rate kiddos, because we know early on who are the ones that are going to be. Yeah. No, you're right. You're exactly right.

[00:09:42] [SPEAKER_02] I want that child going to their mom and say, mom, I need some help with my brushing and flossing.

[00:09:47] [SPEAKER_00] Yeah.

[00:09:47] [SPEAKER_02] Right. And then they do their little calendar and then we're training them by the time they get to be 13, 14 or 19.

[00:09:52] [SPEAKER_00] Yeah.

[00:09:53] [SPEAKER_02] Hopefully that they've improved home care. Yeah. Right.

[00:09:56] [SPEAKER_01] Because there's, well, you know, honestly with just with reps and growing older and understanding what you're trying to do, they probably do like, like, honestly, let's be honest. It's like for some kids, if you're just getting a toothbrush in there at all, it's probably better than what they had been doing. Right. I mean, honestly, that's, that's pretty, that's pretty cool. What kind of mouthwash you like them to use?

[00:10:18] [SPEAKER_02] You know, it depends just act anything that's, you know, fluoride containing mouthwash because at least we're bathing the teeth in something, even if there's chunks of food between their teeth.

[00:10:29] [SPEAKER_01] But, you know. Okay. So I, I gotta tell you this, this is really funny. I have a 19 year old who was diagnosed at three years old with autism and he's probably five to 10% of my patient population. He's, he's a pretty functional dude. He's, he's, he's an odd duck, you know, but he's, he's great to be around and he's I don't know. He's willing to do the brushing. I don't know how well he does necessarily, but, and I've seen them, I've seen them a fair amount. He does better than probably my younger son does even with it. But what's really, really interesting.

[00:10:58] [SPEAKER_01] He's been an act bubble gum guy forever. Right. Religiously. And I'm thinking to myself, God, if I gave this kid one habit that, that was going to be helpful for him. And he, he looks terrific. He looks, he looks considering. Considering, I don't know that, you know, I used to, they hated it because I'd want to brush their teeth. You know, but, but I mean, they, they felt like they wanted to take, take over on this stuff. And that was the habit. And I got to tell you, it's just the dumb stuff you buy at, you know, at Target. Yeah.

[00:11:27] [SPEAKER_01] But, but he's obsessed and he's always, we need more. We need me. He's 19 years old. He still likes the bubble gum floss. God help him. You know, I love it.

[00:11:33] [SPEAKER_02] That's why you establish dental homes early. Yeah. Right. And I think sometimes what happens in areas that may be a little bit more rural, right?

[00:11:41] [SPEAKER_00] Yeah.

[00:11:41] [SPEAKER_02] Where there's not a bunch of specialists around.

[00:11:44] [SPEAKER_00] Yeah.

[00:11:44] [SPEAKER_02] And general dentists, I think, you know, when I was in dental school, I mean, we, my school had a good pediatric program, but if you're not even thinking about that, you may have not gotten that training. So what I would do, you know, if there's listeners that do see a lot of kids in their practice, pediatric dentists usually like the most easygoing and we're all teachers, right? What I would personally do is I would say, Hey, can you come, you know, pick the pediatric dentist that you refer to, right? Can you come into my office and do a little training with my staff? How do you do things? Right.

[00:12:14] [SPEAKER_02] And just that alone, you know, cause we've got handouts, we have all these other things. And just that, and I can send it to you. I don't know if you have a place to post it, but I have a QR code with all the handouts. Okay. We'll put it in the show notes so everyone can get it. I give away, you know, it has all those calendars, brushing and flossing, herpetic genuosomatitis, trauma, all this stuff. I love giving all that stuff away. And, you know, and if an office can just kind of set some protocols, because I don't know

[00:12:41] [SPEAKER_02] if you've seen this, but sometimes new patients that practice, they'll have the kids come in first and then the parents will come in, right? Yeah, exactly. No, that's exactly right. Right. And if you can take good care of the children and the parents will follow, right? Yeah, for sure. So I think just having resources and, you know, just training your staff on, you know, what do you do during a recall? There's little, there's little things, you know, one thing I'll, I'll post, I'll give you is I did a webinar. It was just on fluoride varnish, but I talked about how do you be efficient during a recall

[00:13:12] [SPEAKER_02] and a little bit of that's parent management. So like one thing I, I, we do for every patient is sometimes parents want to come back. Sometimes they don't.

[00:13:20] [SPEAKER_01] Yep.

[00:13:20] [SPEAKER_02] So when we go to the waiting room, when my team goes to the waiting room, we'll ask the parent, you know, Alan, do you want to come back with your child today? Or do you want to just have some dad time? And sometimes parents, you see their faces light up, given the permission, 10 minutes on Facebook, right? Or sometimes they say, just come get me through the exam, right? Or then they say, Hey, I want you to be there the whole time. But how do you feel about that? I like having parents back.

[00:13:44] [SPEAKER_01] God, that's so funny. So like literally, literally, I just, I mean, I might've been in the airport on the way here and I was reading just a, just a flame war on Facebook about parents not being invited, you know, that we definitely don't want to. And my thing is like, I always was like, you know, if they want to be back there, let's just, I don't want to fight. I don't want to, I don't, you know, and my thing is like, it's our policy. I'm like, that's great. But I mean, if the parent really wants to be back there. You have to set it.

[00:14:10] [SPEAKER_02] So Greg Saltus, who's, you know, one of the Kings of behavior management. One, the best thing I ever picked up from listening to his lectures were the idea of silent observer. So if you know that parent is going to be the tiger mom ahead of time, you just say, Hey, mom, I'd love to have you back. Let my team do what we're all trained to do. If you could be a silent observer. And if we need you, we'll ask you to come over. Yeah.

[00:14:40] [SPEAKER_02] They can, you know, make sure if they see all these carries and we just, and hygiene is awful. We get them clean and get out on the waiting room and the parents don't see it. That's exactly right. Oh my God.

[00:14:48] [SPEAKER_01] It's huge.

[00:14:48] [SPEAKER_02] Yeah. So I, you know, it's efficiency. That's one of the big things. Like earlier, you know, I, you and I were talking about AI carriage detection. Yeah. And one of the things I like about that is, you know, let's say you've got a bunch of teenagers in your office. Well, you don't necessarily need to see, have that parent there for that 15 year old, but if your staff takes those radiographs and what I talk about is yellow and pink stop and think. So like Pearl, for example, their colors, you can change the colors, but the base are yellow and pink. Yeah.

[00:15:16] [SPEAKER_02] So if my staff sees there's a bunch of pink and yellow, they automatically, they're going to know, Hey, I may not do the prophy today, but I'm going to call the parent back. I'm going to spend time doing OHI.

[00:15:26] [SPEAKER_00] Yeah.

[00:15:27] [SPEAKER_02] I'm going to get the floss out. I'm going to get the prevalent out. Yeah. Have the doctor come in and spend time just treatment planning and going over whatever they need to, and then do the prophy while during the restorative. I like that. Right. I like that. And if you see a fair amount of kids or teens that can save 20, 30, 40 minutes, you know, and then you're getting the maximum out of that. Isn't that funny too?

[00:15:50] [SPEAKER_01] Because of course everyone, their mindset is like, Oh yeah, I get that prophy done. Like that's talk about a drop of a drop in the bucket. Someone's got a lot of disease. They need a lot. They have a lot of needs. I mean, no offense, but on a kiddo, a prophy is not a particular, like that's a, that's a decent add on to restorative. Yeah.

[00:16:05] [SPEAKER_02] I mean, it's like if you had a big open wound, you're going to sprinkle some antibiotics on top. It's not going to change anything. Right. Yeah. And that's where, in the last couple of years, I've really tried to not be a tooth odontist. Yeah. Look at one tooth at a time. If we look at the oral cavity, we're trying these kids and you see this adults too that come in with just rampant. Yeah. Poor oral hygiene, high caries rate. They're just teeming with bacteria. Yeah. So if you can just go in and do caries control and put some GI and you look at what strip mutans levels are, they drop dramatically.

[00:16:36] [SPEAKER_02] So utilize those appointments.

[00:16:37] [SPEAKER_01] I got to tell you, it's really funny. University of Minnesota was really big on that. All of us kind of thought it was bullshit at times too. But it's not. Yeah. Just think about, I mean, if you had this big, when you think about how great glass ionomer is, fucking dental spackle on that stuff. I mean, it may not even be the end all, but you're really making a difference for the levels of gunk in their mouth.

[00:16:56] [SPEAKER_02] I saw a patient that was from the UK. So they got treated under NHS. I think they were 13. Okay. Just, they must have rampant caries because every one of their teeth had orange triage in it from Fuji. Yeah. And someone went in, just did caries control over the place, put Fuji in, and they didn't see the dentist for like five years. And when I saw them, they were ready to change things out, not having pumpkin teeth. Yeah. There was zero decayed in these teeth.

[00:17:21] [SPEAKER_01] Triage is a miracle. It's a miracle. It really is. It's great.

[00:17:26] [SPEAKER_02] There was nothing. They were all hard as a rock. Well, what happened?

[00:17:30] [SPEAKER_01] This is the thought process that like, it's not treating teeth. It's treating disease. It's treating like, you can look at the whole mouth and see that this is a much better way to spend their time and their effort on the, yeah. Yeah. Oral hygiene instructions.

[00:17:44] [SPEAKER_02] You know, and sometimes we're just trying to get through procedures. Yeah. No, teach them how to clean their teeth. Yeah.

[00:17:50] [SPEAKER_00] Yeah. Right?

[00:17:50] [SPEAKER_01] You know, on the whole, I mean, for his general dentistry, so many practices are driven by hygiene visit, hygiene visit, hygiene visit. And the funny thing about that is, is I don't know many people that do oral hygiene instruction that's worth a damn. Like, here's the thing at the university of Minnesota, I say this and people hate it when I say, cause I haven't made the change yet myself, but there was a room with a bunch of sinks and you'd go in there with the kid and you'd say, okay, I want you to, you would,

[00:18:19] [SPEAKER_01] they would show you how they brush their teeth. You see, you could, you could write it. And I always thought to myself, every office that I have a room with a sink that for kids, adults, anyone, and then also have like a treasure trove of different things that you can use to clean your teeth. Maybe you like, you know, fat floss, maybe you like skinny floss, maybe you like a bigger brush, a smaller brush, whatever. But like, and let these people learn how to do it in the way that they would do it at home. Correct.

[00:18:45] [SPEAKER_01] Cause there's no, I mean, if, if I, you know, if I scrub your teeth with a profi cup or if I use an air polisher or something like that, that's nothing that you're good. You can't do that at home. Great. You get one day of really clean teeth, but you know, what about the other 300?

[00:18:58] [SPEAKER_02] So what I like to do, if we know hygiene was really poor at the previous visit, yeah. Disclosing tablets, right? They're super cheap. Have them. It's so old school. It's so good. But it works, right? Yeah. And because that 13 year old is going to roll their eyes at you, right? You tell them you got to brush and floss. Now, if you put a disclosing tablet in, have them swish around and see the gunk that's on their teeth. And they said, oh, I brushed super well at the time. No, you didn't. Yeah. And they need to see that, right?

[00:19:22] [SPEAKER_00] Yeah.

[00:19:22] [SPEAKER_02] And you know, then hopefully we can, they will learn basic hygiene because we spend so much time.

[00:19:28] [SPEAKER_01] Do you just disclose them at the office? Do you ever have them use at home? All the time. No. Do you have them take them home? Okay.

[00:19:32] [SPEAKER_02] So we'll disclose them. So if hygiene's really poor, they get disclosed. Now, if parents not back, we may just take some photos, right? Yeah. And I have internal cameras at every single, and you don't have to spend a whole lot of money on internal cameras. Yeah. Have an inexpensive internal camera. Yeah.

[00:19:46] [SPEAKER_01] And that way. I don't know. I think you probably need the new microscope. Yeah. You probably need a microscope. Probably every laboratory. Correct. Maybe in the waiting room just for the fun. That would probably help.

[00:19:54] [SPEAKER_02] Yeah. But then, you know, let them see how much goo is on their teeth. And then just have them brush and take that appointment to do some treatment planning or hygiene instructions. Have them come back in a month and say, okay, you work on this at home. Come back for cleaning in a month. And, you know, your office- I love that.

[00:20:13] [SPEAKER_01] Actually, what's funny is you didn't do the profi. You just showed, basically, you showed them up. I love that you just come back. We'll clean them then after you actually know what the hell you're doing. Well, right.

[00:20:22] [SPEAKER_02] I mean, sometimes a profi is honestly for optics. Yeah. Right? Yeah. Because- See what's underneath. Especially if a child's in ortho. Yeah. If they're in fully banded ortho, profi caps are not going to do a thing. No, no. And this is where-

[00:20:33] [SPEAKER_01] You know what I like? I like to take bite wings when they're in full opportunity. That's great. Great. I mean, like, fantastic. If I miss something, you're fine. You're fine.

[00:20:40] [SPEAKER_02] But all these guided biofilm removal, I mean, they're just- They're air polishing, right? There's nothing better than air polishing that kid's in ortho. I mean, it's so fast. Oh my gosh, it's great. Yeah. And I, you know, we've spent so much time with this profi cup. All of these guided biofilm, I mean, that's what we've been doing for a long time is just air polishing teeth. And you're actually removing plaque off teeth, right?

[00:21:03] [SPEAKER_01] Have you done the thing where you disclose like you would for the guided biofilm and use the profi cup? You can get stuff. You can get stuff off. Oh yeah. It's real hard to get in between. Yeah. I don't care what kind of profi cup you got. It's really hard to get in between. Yeah.

[00:21:16] [SPEAKER_02] You know, the most efficient cleaning I see, like if they're in fully ortho, put an isolite in them. Yep. And clean one half and then go to the other half. Yeah. They will be, I mean, they may be bleeding a little bit afterwards, but they're going to bleed no matter what. Yeah. But I really think air polishing is-

[00:21:33] [SPEAKER_01] I just got this new Woodpecker PTE. It's phenomenal. Brand freaking new. I love it. That thing is so cool.

[00:21:39] [SPEAKER_02] Oh my God, is it cool. But it's simple, right? When you think about it. Yeah, it is. I mean, they're expensive units. I don't know why they're all so expensive, but- They're expensive.

[00:21:45] [SPEAKER_01] I think they're better. Like air polishing isn't even all that new, but I think they're better now. They're better and they're less of a mess. They don't break down. Yeah. Yeah.

[00:21:53] [SPEAKER_02] Like I have Aquacare Twin in my office and one side is either aluminum trihydroxid and other side is aluminum oxide or you can put glycine, you can put Hawaiian punch in it. It doesn't matter. But- I like the Hawaiian punch in it. You can put Hawaiian punch in there. But- Red. You want the red for sure. Now I've had my teeth clean with, you know, a breadth of taller, when I'm in the powder they're using and they just feel better.

[00:22:15] [SPEAKER_01] That's what I- You're just removing plaque from teeth. I literally have done all of it. I haven't even handed over to the hygienist yet because I'm trying to figure out how to work with it. So I've done several pro fees on, you know, air polishing patients. I have imperial maintenance for crying out loud. I've done it. And to a T, they've all said, my teeth have never felt this clean after- Because you're actually cleaning them off. It's crazy. It's crazy. And the reality is, is like, when you think about a hygiene mill that's- I don't know.

[00:22:41] [SPEAKER_01] What I'm saying is, I'm like, I'm not sure we're doing them huge favors by doing a half-assed job with hygiene and not doing, not spending more time on oral hygiene instruction.

[00:22:50] [SPEAKER_02] I just, all of these, I've just seen it for so many years because I've used a BioClear Blaster, AquaClear Twin. And that was before this whole crave of, you know, guided- They are.

[00:23:01] [SPEAKER_01] I mean, it is, it's a bit of a money- Someone said something. It's a bit of a money-making thing. It's like, if you call it guided biofarm therapy, you can charge a lot more. And the reality is that sort of, you know, if you look at it, but they work awesome. They're fantastic.

[00:23:12] [SPEAKER_02] I think the thing is with those units is, it's water. Those units get beat up. You're using high pressure. Yep. You know, you're using a powder, using water. And what you're paying for is they, they last. Reliable as hell, yeah. Right. Because you don't want the thing going down. Yeah. You've got, if that's what you're cleaning teeth with. Then your hygiene column goes away for the day. Yeah. Right. Yeah. And you just do a good job with me. And you're not, your wrist isn't bugging you as much. Fuck. It's fast.

[00:23:38] [SPEAKER_01] It's right. It's like, that's, you don't sleep on that. I mean, like, okay. Anyway, as, as the hygienists would say, it's fast. You can spend more time on oral hygiene instruction, which is great. But the reality is like, like what the amount of time it takes to do a, a typical appointment in hygiene with that thing is, I bet it's halved. I mean, like the actual instrumentation. It's wild.

[00:24:03] [SPEAKER_02] And you're going to clean better around brackets of gingival. Yep. And I just, I wish more people use them. And even if, you know, someone's looking at you, they don't want to spend 12 grand or whatever on them. Yeah. Just buy an inexpensive eBay unit. Get some, you know, erythritol powder just to try it out.

[00:24:20] [SPEAKER_01] You'll do it and you go, oh, wow, this is good. Right. Those things will break in about two minutes. I mean, if you buy it somewhere that sells like car parts. So you talk about the AquaCare Twin. It's a, it's, it's a different, the hand pieces are way different. Basically the hand pieces are like those little tubes and then, and then it splits them and then you use a disposable tip that, that combines the air and the water together. So allegedly they don't really break down because there's many less places for them to get plugged.

[00:24:47] [SPEAKER_00] All my other air breach units.

[00:24:48] [SPEAKER_01] They are, they are, and they're so simple. There's no electric anything. I mean, it's literally just air and you've got a water. I mean, I've got one there. I don't use as much as I should. I'm getting back into it, but I had a, I had a hang up with any, with powder medium because it was a mess. And I'm all of a sudden like, you know what? You got to turn your water up a little bit more then. Yeah.

[00:25:05] [SPEAKER_02] And put an isolate. Isolate. Isolate.

[00:25:07] [SPEAKER_01] Exactly. If you get, I use a Mr. Thirsty and in the, you know, the thing about it is, is that it's, it actually what I have been doing is overkill. Cause I just like to throw money at problems. An opter gate, an opter gate first, then a Mr. Thirsty. I'm like, you can't, you could barely get a person a wet with that thing. It's amazing.

[00:25:23] [SPEAKER_02] What I like in the interior, if you really need isolation is a isolate anterior. You put that mouthpiece in and then your rubber dam over it. I've been doing that probably the last couple months. Okay. Those teeth are dry because you know.

[00:25:36] [SPEAKER_01] So you, so you're putting in the isolate and a rubber. It's like the turducken. It is like the turducken.

[00:25:41] [SPEAKER_02] But it, it's holding the tongue back. It's suctioning. It's holding the lips out of the way. And then, you know, if you're just putting like, I had a patient broke a couple lower anterior teeth. Yeah. Then just punch holes, put the rubber dam on. Yeah. You just use wedget or pieces of rubber dam. Yeah. And that's the best of both worlds. And it seems a little excessive, but you know, if I.

[00:26:01] [SPEAKER_01] That patient couldn't drool on your prep. There's no way. There's no way.

[00:26:05] [SPEAKER_02] Physically couldn't do it. And you know, I just, it's dry. You can see. Yeah. It's, you know, you spend a little bit, you know, it's overhead, but if that was me, I always think about if it was me, right? What would I want? One of the best line. I just, a couple of weeks, I was talking to a dentist and she had some new associates in her practice. And some of them were under treatment planning. Some were over treatment planning. A lot of them were under treatment planning because they were new and they didn't want to be too aggressive. Her line was diagnose like all the treatments going to be free.

[00:26:35] [SPEAKER_02] Yeah. And that will help guide you on what the best thing is for the patient. Yeah. That was really powerful.

[00:26:41] [SPEAKER_01] Yeah. Yeah. Yeah. I just talked to Marco too. And his, his point was when you're, when you're talking about options with a patient and this is, everyone's always said this, but it's kind of real. It's like, what would I want with knowing my skillset, knowing my skillset, I'm delivering the care. What would I want? And I'm like, wow, that's powerful stuff.

[00:26:59] [SPEAKER_02] And then let the patient chew. Just give them options. We're all guilty of this. You know, I think sometimes the general public, they think we're doing the Scrooge McDuck thing at home with our gold. Yeah. Right. And we just put the gold coins. I am.

[00:27:08] [SPEAKER_01] Actually, I like the, I like the, the, the dive in first. Oh yeah. The skis down the mountain of cash. I like that. That's a, that's a nice touch.

[00:27:15] [SPEAKER_02] But I would say 95% of dentists I know, their primary focus is do the best work possible for their patients. Right. It really, and I wish the public really understood. Yeah. There's, there's, you know, there's bad actors in every field.

[00:27:29] [SPEAKER_01] But I have a real chip on my shoulder about this because first off, we're, we're as a, as a, uh, a profession, we're not very, uh, there's not a lot of empathy towards us because what we do is we do surgery on awake people and tell them how much it's going to cost. It's like all the worst. And of course it may not hurt until they go in. Yeah. And then in medicine is the exact opposite. They do everything asleep. You can't, you know, they do everything asleep. Right. And, and they never tell you what stuff's going to cost.

[00:27:57] [SPEAKER_01] It's the, you know, the classic thing where we need to do this treatment. And if their insurance doesn't cover it, they're just going to send them to collections. You know, like there's, they don't even, there's no conversation about money. And the reality is, is I wonder about informed consent if you're not talking about money, but I mean, neither here or there, every medical treatment I've had since forever, there's never any talk. You're not going to ask.

[00:28:14] [SPEAKER_02] I mean, if you need a big surgery, you're not saying, well, I'm going to go down the street. How much is this guy? Is this hospital less? I get it.

[00:28:19] [SPEAKER_01] But on some level, I mean, how much imaging is done? That's like, eh, maybe we should get an MRI. And then when you find out it's going to cost you 2,500 bucks out of pocket, you're like, how important is, what are we going to learn? Like, that's real. And I don't, it doesn't bother me when patients don't want to talk about x-rays because I can explain why we're doing it. You know, it's like, it's, it's wild.

[00:28:40] [SPEAKER_02] I stop fighting. You know what I've done? And we all give away too much, but sometimes if they don't want to, I said, is this a cost thing? Yeah. Because what I don't want to have happen is we all know you cannot sign and form consent to patients. You know, they say, I'll sign a piece of paper. So I don't, you know, you're not. I'm not liable if I take, you know, sorry, that's not how it works. Yeah. And sometimes it's like, I don't want to fight over the bite wings. Listen, I'm going to take some bite wings and inevitably they're always going to have decay most of the time. Right. That's the, exactly.

[00:29:06] [SPEAKER_02] Um, yeah, you know, we just have to be sometimes advocates for their patients and, and explain things even though they may not want it. And I think as a practitioner, after you work for a while, one of the nice things is you realize you don't have to be everybody's dentist. Yeah. Right. Yeah. No, that's right. Sorry. It's not going to work out.

[00:29:22] [SPEAKER_01] I also think I, this is terrible, but I think a little bit of gray here goes a little bit of a long ways with that too. Nope. It goes a long ways with that. And you know, if you've, how often is, I mean, if it's been a patient of record for a while, if, if I have to come in and explain what the x-rays are about, they're going to do them. I'm going to be able to explain it. I'm like, a lot of times the hygienist assistants are like, I can't believe it. And like, if you come in, you're the voice of authority, which is fucked up, but it's true. It is. I mean, like, I, I just don't run into that very often.

[00:29:52] [SPEAKER_01] And there's, like you said, if the, if that's really their issue, right. They don't. Yeah. There might be other people that would be okay with that too. You know, it's, and we can leave as friends, you know, it's like a.

[00:30:02] [SPEAKER_02] Well, I think, you know, you're an excellent, I mean, you're a communicator for a living, right. As what you do in podcasts and what you do in the office. And that's one, I know we're jumping all over subjects, but that's one thing. If I was a newer dentist, I would take some classes on interpersonal communications, right. Yeah. Especially in AI world where everything is like computer generated. And I think these things are going to be more important, right. Because people are going to come in, they're going to do the research, but just building that rapport with the patients.

[00:30:32] [SPEAKER_01] Making a connection makes a big difference. Well, you know, my dad, you know, practiced for 40 some years and when he'd come in and say, tell the patient they needed a crown, you know what? They just did the crown. Right. I mean, why was that?

[00:30:46] [SPEAKER_02] It was because they trusted him because he spent the time. Yeah. Didn't have his hand on the door. Yeah. And they trusted that he was going to do the right thing.

[00:30:52] [SPEAKER_01] And he had a, I like showing patients stuff. I like, like the reality is like, I can, I can explain stuff and patients trust me, but even better when I just like, look at that. And the patients are, I can explain and the trust is good, but I like it when they come to that, when they realize themselves.

[00:31:10] [SPEAKER_02] Do you ever ask the patient, do you want, I heard this one time and I thought it was really good. I remember where, but someone's talking about treatment planning and they ask their patients every time, how much detail do you want to know? Yeah. Would you like me to sit here and go through every tooth? Because if you want to, I'll do it and show you exactly where decay is and where it needs to be done. Or do you just trust someone to do the best thing for you? I like, I forget about asking that because sometimes I feel like we're going to this,

[00:31:37] [SPEAKER_02] I'm going over all these little things on the x-rays and parents thinking, I just want to get out of here. Like take my kid to lunch. Right. Yeah. So I got some fruit by the foot in the car by the foot. Because some, you know, if you have that report, they may not care. They just know doc, I know you need to have it done. And then you just ask.

[00:31:52] [SPEAKER_01] I'm actually okay with all of that. Both of those answers are pretty good to tell you the truth. And I don't, I don't, I'm not as explicit about asking that as I should be. That's a great question. And it also gives the patient a fair amount of autonomy. For someone who's already bought into that you're going to do the right thing, you don't have to spend as much time with them. And there's some that may want to know everything.

[00:32:11] [SPEAKER_02] Yeah. That's fine. Yeah. I mean, if it's their mouth, that's what they're paying for that visit. Yeah. And I think that needs to be part of informed consent. If they really want me to go through the x-rays for a long time. Ooh, I'll give you one other thing, a little hit. So if you are treating, you know, because a lot of times in your offices, mom or grandma or something's bringing in child. Yeah. So what I try to do now is if it's one parent, I know it's a complex treatment plan. Yeah. I'll stop and say, would you, do you think you're the other, be careful.

[00:32:38] [SPEAKER_02] Would you like the other parent to, you know, would they like to know more about this? Yeah. And I have them just take their phone out and turn on, you know, just record video on their phone. Oh, that's a great idea. And that way I'm not doing consults at lunch or after work or whatever. Yeah. And then I really feel like that other parent, I find my success rate of them coming back is higher. Yeah. Because there's a lot of times, you know, the mom or the dad, it's usually the dads that come to the visit and they're not asking any questions.

[00:33:03] [SPEAKER_01] They're tuning out. Yeah.

[00:33:04] [SPEAKER_02] Correct. But then, hey, you've got it recorded and then I'm not doing these, you know, you get the call afterwards from the mom. Hey, I'm at home. I couldn't be in there.

[00:33:11] [SPEAKER_01] I got to say one of the orthodontists that I refer to on complex cases, he'll record the treatment plan on a loom. That's what mine does too. I'm thinking to myself, man, that's a great idea. And what's funny is he can record it in a matter of a few minutes and he didn't have to worry about me calling him at the exact wrong time to talk about it or whatever. And then he's like, hey, we need to talk about this. It's a good idea. Yeah. And honestly, there's no reason that we couldn't do that as for, you know, complex restorative stuff or whatever as well, because it's also kind of a record of what you're thinking. Anyhow. Exactly.

[00:33:40] [SPEAKER_01] I mean, there's, there's kind of some wins there and that's an easy technological fix. You can literally do that in and off. Yeah, exactly. Take a photo. You're good. Yeah. This is great. Josh, we've been going for a while. I feel like we could do this more. So maybe we will, maybe I'll get you back. Sure. And I'd love to, but we didn't, we didn't talk about BioClear. Like we are at the BioClear summit. Just, you know, we didn't talk about BioClear. There's other stuff, but it was a great summit.

[00:34:00] [SPEAKER_02] So it was, and like I said, I'll put together, you know, it's really important for me, especially now that I've practiced for 23 years, I've got big libraries of stuff and I'm turning to my grandmother. You come over like here, take this, take this, take this. Right. But I'll put together. I've got some really good libraries of just getting an all-in-one kit for the general dentist of handouts. I love this. It's great. Post-op instructions and all that stuff. Okay.

[00:34:22] [SPEAKER_01] It's fantastic. I love it. Josh, it was nice to meet you in person this weekend. It was great to do this too. Thank you so much. All right. We'll talk to you soon. Take care.

[00:34:28] [SPEAKER_00] Bye.