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Hey guys, before this episode begins, I just want to let you all know that I've partnered

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Hey guys, welcome back to the DOSEDENTAL podcast.

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We are super excited to be joined by Dr. Nincastro, a general dentist, educator at the Silver

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Book School of dental medicine, and a private practice owner.

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We will be discussing Dr. Nincastro's journey to dentistry, as well as his advice and experience

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in running a private practice.

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If you liked the episode, be sure to follow us on Spotify and our podcast, and leave a

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review of things that you liked and what you want to see more of.

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Enjoy!

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So, what's the right into it?

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Siraj is an undergrad at Stony Brook University.

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We actually met at the gym playing basketball years ago, at the sports club.

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Siraj, I met Dr. Nincastro at the sports club.

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Oh yeah, I see.

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Dr. Kaplanow, yeah.

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Yeah, yeah.

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I was way back then.

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I don't even think it's a gym anymore.

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I think it's a ball.

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I heard it though.

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I heard it's a pickleball.

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They do a pickleball place now.

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We should go.

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Sorry, I wrote the corner.

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That's what I heard.

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One of my buddies told me about it.

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I'm like, yeah, you know.

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So that was, yeah, that was our place, you know, five o'clock in the morning.

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That's right.

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I mean, I saw you mostly on weekends because it's over at seven.

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Yeah, definitely.

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Yeah, and so.

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I couldn't make those five ends, but I went to Stonyburg dental school.

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Dr. Nincastro went to Stonyburg dental school and then went to St. Charles for GPR residency

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and then from there.

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Who did?

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Who did?

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I didn't go.

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Did you go to St. Charles?

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No, I was at Stonyburg AEGD.

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AEGD.

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Oh, okay.

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Oh, no, no, no.

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But you used to go to the OR, I thought, with Dr. Kaplanow at St. Charles.

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So the OR, no, I never went to the OR with Dr. Kaplanow at St. Charles because I would

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have to work at St. Charles too.

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I met Dr. Kaplanow when I was a fourth year dental student going through Nassau County

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Medical Center.

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That's when, okay.

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And I was going to an externship in oral surgery and he was the chief resident at the

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time.

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That's where we met.

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So I was still a dental student when I met Dr. Kaplanow.

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And he was a surgery resident.

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God, sure.

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God, sure.

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Okay.

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And he had a lot of pieces there.

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And then, so AEGD at Stonyburg.

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And then you went out into private practice.

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Then I went out into private practice.

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So my dad was a dentist and I went in with him.

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So the funny thing is, and things have changed a little bit, but when I was in my fourth year,

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it was a decision whether to do a residency or go right into private practice.

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And I decided to do a residency.

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And I got to tell you, it was the best thing I ever did.

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And the reason why I decided to go into a residency is because I wanted to learn more

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and I wanted to learn from different people.

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I knew that my father could teach me, but like I wanted to have, I didn't want to just

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become a clone.

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I wanted to have different influences.

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So I was very, very lucky that I trained under some really great faculty.

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When I was in AEGD, Doug Firth, Mark Pancado, there's so many great faculty, Mark Slovin,

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I mean, so many good dentists that I got such great training.

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And so when I walked into private practice, I was ready to go.

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I was ready to go, for sure.

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And then I learned a lot from my father when I started practicing as an associate.

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And the great thing about it was my dad was very big in implant dentistry.

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And so I naturally had to be good at implant dentistry.

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And the Sony Brook AEGD training with Mark Firth and Mark Pancado, they were big in implant

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dentistry and they liked implant dentistry.

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So I learned a lot from them.

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So when I jumped in, I already had a head start and everything like that.

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And then working with my dad was great.

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I mean, I learned a lot.

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He was a great teacher in certain things.

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And we did not always agree.

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And that was one of the great things about doing a residency because if I would have

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came out just out of dental school, I would not have certain, I would have just become

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a clone.

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And now, so there were some instances where he would take what I learned and apply it

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to what he was doing.

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Really?

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Make some changes.

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Yeah.

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Because what happens in private practice is, if you are not, you got to be careful in

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private practice because you can get into this little box where you're not interacting.

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And there's so much to learn from other people.

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And so you always got to consistently learn.

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I never stopped learning.

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I still learn to this day.

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It's just crazy.

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I always try to surround myself with people who can teach me more and everything like

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that.

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And by fall, you never stop learning.

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What's a consistent way for, so say you're, I mean, you do this every year, right?

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I know you go on some trips where you take the courses, but are there any other methods

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and if we could go into that even to continue learning and staying on the top of your game?

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And just like you said, you don't get fixed in a box in your own private practice.

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You're constantly taking from and learning from others and then applying it every day.

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So I got to tell you, so there's online courses that you could take, which are great.

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Okay.

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And you could, you know, and I'm a big YouTube watcher.

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I watch YouTube like, like I'm a dental geek.

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I'm going to tell you right now, I'm a dental geek.

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So like, like if I'm like, you know, we could be, everybody could be watching TV and I'm

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on YouTube looking at a video on like, you know, a certain implant technique or something

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like that.

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And that's just like what I call passive learning, right?

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Yeah.

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So possibly learning stuff, active learning wise, especially when you're young.

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The biggest mistake that I think young, young dentists make is they're afraid to invest

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in their cell and themselves.

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They're afraid to spend the money.

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So you have to spend money on yourself.

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You have to invest in yourself.

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Okay.

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So don't be afraid to take that hands.

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The hands on courses are really the best courses to take because then you have somebody

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watching and teaching you a technique.

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It's not just didactic, which is very important.

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Don't get me wrong.

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But yeah, but the hands on technique is, is crucial.

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Okay.

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The best courses that I feel are the ones that set you up didactically for the first

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couple of days.

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And then now you go do hands on.

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Those are the best courses.

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But you, you could always passively learn all the time.

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You could passively, I never like, you know, like if I'm doing a big case with Dr. Capuano

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or Dr. Gish and they're doing something, I'm watching.

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I'm watching the surgery.

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I'm watching how you like, you know, how you do place implants, but I learned from them

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all the time.

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Right.

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And I'm like, I'm just going to do it because they, you know, you just learn, you watch

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people do things and you, and you ask questions and you just actively learn all the time and

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everything like that.

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So you never, you never stop learning.

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But the biggest mistake I really think I see it all the time is like, you know, I really

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want to take course on it, but it's really expensive.

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Yeah.

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But you're investing in yourselves and your dad will pay you back.

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You will, you will, you will make headway just by doing that course.

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There's no way you won't.

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And I didn't take course.

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I wish I took course.

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Of course.

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One of the biggest mistakes I felt as a young person was I didn't take a, so course is a

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select like a series of courses and you graduate from their program.

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Right.

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Right.

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And well, but like, so there's Dawson and one does it the same way and stuff like that.

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But it really sets you up to understand certain principles like occlusion, which I don't think

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you get enough of in dental school.

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And then, then you jump into prosthetics and you can't really do prosthetics effectively

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without understanding occlusion.

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Right.

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You know, you really can't.

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And I feel like occlusion is just kind of past, you know, it's really just touched on

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in dental school, not, you know, and everything.

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That's true.

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That's true.

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You know, we touch on it and we go into a lot didactically, but seeing it clinically

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and then working with it clinically that you're right.

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We miss out a lot of that.

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And it's not the school's fault.

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There's so much to teach, right?

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So it's like, I'm big on occlusion in a click.

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I mean, I'm sure you get to talk to some of the fourth year students now, like I tell

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them the thing that will kill your work the fastest is occlusion.

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If you don't have proper occlusion, right, if you'll work, it'll kill what you did and

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stuff like that because, you know, it gets beat up all day long.

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Yeah.

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Yeah.

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I mean, just think about it, you know.

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It just gets beat up all day long.

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So I mean, occlusion, I think it's just passed upon a little bit and like, I really felt

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like TMJ, we didn't learn a lot of TMJ stuff, you know, but that could be a whole six months

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course on itself in TMJ.

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You know, it's a lot.

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It's a lot, all right.

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I'm going to think of it right now.

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Yeah.

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There's a lot going on there.

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I mean, it's functional, there's myofascial pain, there's, we could go on for days and

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that, but Dr. Cascio right now, and has this changed over the course of your career, your

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favorite treatment to go into with a patient?

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Yes, it has.

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So I think when I was in the middle of my, like, so maybe five, six years in, I would

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tend to complicate treatment, like get, try to get fancy, like try to do like, you know,

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want those, that big laminate case or big stuff like that, or do this big thing.

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What I find now is I try to simplify treatment.

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I try to keep things simple and you always tend to have the better outcomes at Web A and

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stuff like that.

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And what I mean, keep simple, I'm not saying so like when, so like, you know, back in the

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day, we used to do roundhouse bridges and stuff like that, which I was never a fan of,

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but I always looked to break up work.

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So if I could put implants in and separate work, like so well, if somebody needs a full

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large restoration on natural tea, and instead of doing a whole bunch of bridge work, I'll

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break it up with implants.

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What I'm saying?

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And you're keeping the dentistry smaller.

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Right, right.

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And that's, that's honestly what I try to do, but you have to understand when you're

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treatment planning for patients, and I really feel like, you know, we teach this a lot with

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the residents is they should have three options at least for treatment.

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They should have like, you know, this is like, you know, the Ferrari of treatment, right?

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This is like, you know, the Nissan and this is the Pinto.

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But it's all good treatment, right?

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And because now everybody could afford to do a full large of implants and stuff like

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that.

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So you have to be able and you have to be sensitive to that.

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Right.

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So you have to be sensitive to that.

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So not one treatment plan fits one, but you have to give patients options and educate

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them on the options and then let them make the decision what they want.

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Right.

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That's really, that's really important.

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I mean, that's really important.

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Because you're treating all kinds of patients, like, you know, and everything like that.

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So, and you have to be sensitive to that.

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100%.

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I'm just learning about that sensitivity now and being able to divide things up based

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on the patient's needs, which sometimes is financial, you know.

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Yes.

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And just like you said, they're all good treatment plans.

245
00:12:54,600 --> 00:12:57,280
You know, that the car will get you from 8.8 to point B.

246
00:12:57,280 --> 00:12:58,280
Right.

247
00:12:58,280 --> 00:13:02,280
And I mean, and that's the whole thing is so and like, so you're doing right by the

248
00:13:02,280 --> 00:13:08,600
patient and when people talk about like, you know, I have, you know, students ask me,

249
00:13:08,600 --> 00:13:10,760
you know, the doctor, the doctor, what do you do for advertising?

250
00:13:10,760 --> 00:13:12,760
I don't advertise at all.

251
00:13:12,760 --> 00:13:15,640
Never I've never advertised in my life.

252
00:13:15,640 --> 00:13:21,280
All my advertising was from other patients and I don't care.

253
00:13:21,280 --> 00:13:22,800
I'm not saying it's bad to advertise.

254
00:13:22,800 --> 00:13:24,520
It just wasn't my thing.

255
00:13:24,520 --> 00:13:30,880
The advertising to your best referral or your best advertisement is going to be the patient

256
00:13:30,880 --> 00:13:32,840
that leaves your office.

257
00:13:32,840 --> 00:13:33,840
That's right.

258
00:13:33,840 --> 00:13:34,840
That's right.

259
00:13:34,840 --> 00:13:36,560
We're now 100% is going to be that.

260
00:13:36,560 --> 00:13:38,560
So what do you do for that?

261
00:13:38,560 --> 00:13:43,920
So the only thing patients know, and this is the truth, your colleagues and your specialists

262
00:13:43,920 --> 00:13:47,160
that you work with know if you do good work.

263
00:13:47,160 --> 00:13:48,720
The patients don't know.

264
00:13:48,720 --> 00:13:49,720
Right.

265
00:13:49,720 --> 00:13:50,720
That's true.

266
00:13:50,720 --> 00:13:57,560
The patients only know that you were nice and that you took care of them in a compassionate

267
00:13:57,560 --> 00:13:58,680
and pathetic way.

268
00:13:58,680 --> 00:13:59,680
That's it.

269
00:13:59,680 --> 00:14:00,680
Okay.

270
00:14:00,680 --> 00:14:06,040
But as I think it's a good thing, your colleagues will tell you if you're doing bad work.

271
00:14:06,040 --> 00:14:07,040
Yeah.

272
00:14:07,040 --> 00:14:08,040
Right.

273
00:14:08,040 --> 00:14:12,360
So the specialists you work with won't refer anything to you if you're not doing good work.

274
00:14:12,360 --> 00:14:16,160
You'll have work come back to you where they swear on another dentist and it wasn't good.

275
00:14:16,160 --> 00:14:17,160
Okay.

276
00:14:17,160 --> 00:14:20,800
I mean, so that's really like, so you have to do good work.

277
00:14:20,800 --> 00:14:21,800
Okay.

278
00:14:21,800 --> 00:14:27,840
But it's really, the patient doesn't look in their mouth and see how you, the anatomy

279
00:14:27,840 --> 00:14:31,120
you put in a MOD composite restoration, right?

280
00:14:31,120 --> 00:14:32,120
Right.

281
00:14:32,120 --> 00:14:37,720
Which is, you know, it's, or doesn't know that the margins are so great around this crown.

282
00:14:37,720 --> 00:14:38,720
Yeah.

283
00:14:38,720 --> 00:14:44,360
If somebody else who else is looking at it knows if it was that, that's, so like that's

284
00:14:44,360 --> 00:14:45,760
the difference.

285
00:14:45,760 --> 00:14:50,000
So I, so you always, you always have to be empathetic.

286
00:14:50,000 --> 00:14:53,760
You always have to be nice, right?

287
00:14:53,760 --> 00:14:55,720
And you'll get more patience that way.

288
00:14:55,720 --> 00:15:00,040
And when you do good work, you know, and you do do that cosmetic case or something like

289
00:15:00,040 --> 00:15:05,360
that, that's where you get, so if it looks good, you're going to get a referral from,

290
00:15:05,360 --> 00:15:06,880
it could be two years later.

291
00:15:06,880 --> 00:15:07,880
Right.

292
00:15:07,880 --> 00:15:14,000
Oh, I saw that you did, Mrs. Jones is deep and like, you know, and so they, they'll come

293
00:15:14,000 --> 00:15:16,600
up to you and you did, you know, you did eight lab and it's on them.

294
00:15:16,600 --> 00:15:19,520
And so I want that I'm like, but you don't need eight lab, you need this.

295
00:15:19,520 --> 00:15:20,520
Right.

296
00:15:20,520 --> 00:15:24,600
So like, you know, like, so that really gets the same case, but like something like that.

297
00:15:24,600 --> 00:15:27,640
Like that's, that's kind of like how it worked.

298
00:15:27,640 --> 00:15:31,360
And that's how I practice still, like, you know,

299
00:15:31,360 --> 00:15:32,360
Yeah.

300
00:15:32,360 --> 00:15:33,360
Yeah.

301
00:15:33,360 --> 00:15:37,120
And I mean, and your practices, it's expanded in, in itself, because now in the beginning,

302
00:15:37,120 --> 00:15:38,760
it was you and your dad, right?

303
00:15:38,760 --> 00:15:39,760
Right.

304
00:15:39,760 --> 00:15:40,760
100%.

305
00:15:40,760 --> 00:15:41,760
Yeah.

306
00:15:41,760 --> 00:15:42,760
So it was just you.

307
00:15:42,760 --> 00:15:45,360
How, how many years was it just you two under the same roof like that?

308
00:15:45,360 --> 00:15:47,360
13 years.

309
00:15:47,360 --> 00:15:49,360
13 years.

310
00:15:49,360 --> 00:15:50,360
13 years.

311
00:15:50,360 --> 00:15:51,360
Yeah.

312
00:15:51,360 --> 00:15:52,360
Okay.

313
00:15:52,360 --> 00:15:53,360
Just you two.

314
00:15:53,360 --> 00:15:54,360
Yeah.

315
00:15:54,360 --> 00:15:58,360
I was, I was alone for two after that.

316
00:15:58,360 --> 00:16:01,840
And then I got an associate after that.

317
00:16:01,840 --> 00:16:10,000
And the problem was, is when he decided to retire, it was a two man practice.

318
00:16:10,000 --> 00:16:13,520
And I was trying to find the right person.

319
00:16:13,520 --> 00:16:17,240
And so like for two years, I was kind of, you know, doing, and I was kind of doing, I'm

320
00:16:17,240 --> 00:16:20,320
learning a two man practice by myself and it was busy.

321
00:16:20,320 --> 00:16:22,560
It was really a little bit too busy.

322
00:16:22,560 --> 00:16:27,080
I always say this, it's good to be busy, but you don't want to be unproductively busy.

323
00:16:27,080 --> 00:16:33,120
Now everybody can get your attention that you didn't, that they need.

324
00:16:33,120 --> 00:16:39,800
So it's, so it is a, it's great to have, you know, to have another dentist working with

325
00:16:39,800 --> 00:16:40,800
you.

326
00:16:40,800 --> 00:16:41,800
I love it.

327
00:16:41,800 --> 00:16:42,800
Having another dentist.

328
00:16:42,800 --> 00:16:45,880
I always will love having another dentist work with me because it frees me up to do other

329
00:16:45,880 --> 00:16:46,880
things.

330
00:16:46,880 --> 00:16:50,760
Also, it's, it's good because you can talk about cases together, you know, and stuff

331
00:16:50,760 --> 00:16:55,080
like that and, and, you know, like, I learned and teach from each other and everything

332
00:16:55,080 --> 00:16:56,080
like that.

333
00:16:56,080 --> 00:17:01,000
I mean, that's, so it's really like, I like a group practice model for sure now.

334
00:17:01,000 --> 00:17:02,000
Right.

335
00:17:02,000 --> 00:17:06,640
Because you don't, you tend not to get put in, you get locked into that little box when

336
00:17:06,640 --> 00:17:10,080
you're, when you, when you have other people working with you, right?

337
00:17:10,080 --> 00:17:12,600
So I mean, that's, you know,

338
00:17:12,600 --> 00:17:13,600
Right.

339
00:17:13,600 --> 00:17:15,000
It encourages that communication.

340
00:17:15,000 --> 00:17:18,000
And then with that communication, you're learning what others needs are, what others

341
00:17:18,000 --> 00:17:22,480
like to do with you, what you need to do for them, what they need to do for you.

342
00:17:22,480 --> 00:17:25,480
Those two years alone, was it Dr. Felpo that came on?

343
00:17:25,480 --> 00:17:28,200
If there was a different Dr. Felpo came in after that, right?

344
00:17:28,200 --> 00:17:34,320
It was, oh, so this was, so when we had met, that was right around the time.

345
00:17:34,320 --> 00:17:40,200
I mean, we're going back, what, like, we're going back a good 11, 12 years now.

346
00:17:40,200 --> 00:17:42,800
That was when your father retired in this.

347
00:17:42,800 --> 00:17:44,240
So he just about was out.

348
00:17:44,240 --> 00:17:45,760
He was almost out, right?

349
00:17:45,760 --> 00:17:50,680
So the people who's coming in, who's more going part-time and stuff like that.

350
00:17:50,680 --> 00:17:54,480
And from there, yeah, it's tough.

351
00:17:54,480 --> 00:17:58,520
I gotta tell you, so it's tough when you lose a partner.

352
00:17:58,520 --> 00:18:02,480
Well, you know, he retired and I bought him out, right?

353
00:18:02,480 --> 00:18:05,440
And, and now I have that owned the practice.

354
00:18:05,440 --> 00:18:08,000
And it was, it was tough.

355
00:18:08,000 --> 00:18:09,600
It was, it was a lot.

356
00:18:09,600 --> 00:18:10,600
There was a lot.

357
00:18:10,600 --> 00:18:15,680
It was a lot of like, you know, because, you know, I get calls on a Sunday morning, like

358
00:18:15,680 --> 00:18:20,520
you know, you know, I mean, that happens and stuff like that.

359
00:18:20,520 --> 00:18:23,320
So did you like, did you absorb his patience after that?

360
00:18:23,320 --> 00:18:25,200
Yep, 100% of them.

361
00:18:25,200 --> 00:18:26,200
Yep.

362
00:18:26,200 --> 00:18:29,120
Well, so I mean, and, and like he was busy.

363
00:18:29,120 --> 00:18:31,080
He wasn't like he wasn't a busy dentist.

364
00:18:31,080 --> 00:18:37,680
He was busy and, uh, you re-bolt like I was busier than him by that time, but like he

365
00:18:37,680 --> 00:18:41,400
still was busy enough where I needed help for sure.

366
00:18:41,400 --> 00:18:42,400
Yeah.

367
00:18:42,400 --> 00:18:45,920
And I was like, I'm gonna get a job like that.

368
00:18:45,920 --> 00:18:50,840
And then I decided to take a, uh, a dentist fresh out of residency who couldn't, didn't

369
00:18:50,840 --> 00:18:54,560
have the skillset yet that my father had, right?

370
00:18:54,560 --> 00:18:58,240
But it was great because then you, you, then you teach him, right?

371
00:18:58,240 --> 00:19:04,200
And then you, you know, or her, you know, and then you, and then you, you know, they,

372
00:19:04,200 --> 00:19:05,440
they get better skillset.

373
00:19:05,440 --> 00:19:09,240
They go, they move up and then you could see the progression and how they get better and

374
00:19:09,240 --> 00:19:10,240
stuff like that.

375
00:19:10,240 --> 00:19:14,360
And it's great watching and that's one of the reasons why I love teaching.

376
00:19:14,360 --> 00:19:17,600
Uh, it's, it's great seeing light bulbs go on it.

377
00:19:17,600 --> 00:19:18,600
It depends.

378
00:19:18,600 --> 00:19:21,840
Like, you know, like they're, they're, so they've been sitting in dental school and

379
00:19:21,840 --> 00:19:25,800
they're sitting in class and then like all of a sudden you tell them that they do something

380
00:19:25,800 --> 00:19:28,120
and you say, well, I would, this is, you need to do this.

381
00:19:28,120 --> 00:19:30,480
And then I'm, you say, well, they can see why, and then they do it.

382
00:19:30,480 --> 00:19:32,160
And they're like, oh my God.

383
00:19:32,160 --> 00:19:33,960
Now I know why I learned this, right?

384
00:19:33,960 --> 00:19:35,400
Now I know why I did this, right?

385
00:19:35,400 --> 00:19:40,200
So I mean, it kind of, when you see it all start to come together is, is pretty cool.

386
00:19:40,200 --> 00:19:43,720
That's awesome to see.

387
00:19:43,720 --> 00:19:45,240
I've seen that too.

388
00:19:45,240 --> 00:19:48,440
And you know, you've had my light bulb go on, go on a bunch of times, you know, I've

389
00:19:48,440 --> 00:19:49,960
learned so much over the years.

390
00:19:49,960 --> 00:19:53,840
Um, I kind of wish in some ways I was still at Stony Brook, you know, so I could come

391
00:19:53,840 --> 00:19:55,760
in and see him always.

392
00:19:55,760 --> 00:19:56,760
So it's funny.

393
00:19:56,760 --> 00:20:00,360
It's like you look back like everybody complains about dental school a little bit and stuff

394
00:20:00,360 --> 00:20:02,720
you, you know, about it because it's definitely a lot of busy.

395
00:20:02,720 --> 00:20:03,720
It's a lot of pressure.

396
00:20:03,720 --> 00:20:07,400
It's like, you know, and I, you know, definitely when it's about board time, I could see like

397
00:20:07,400 --> 00:20:12,280
everybody's a little uptight, but you look back on it and you're going to look back on

398
00:20:12,280 --> 00:20:16,920
it and be like the connections you made, the friendships you had, faculty that you met.

399
00:20:16,920 --> 00:20:20,440
I mean, all that you'll do, you'll never, you'll never forget it.

400
00:20:20,440 --> 00:20:23,280
And it ends up being, it ends up being a good thing.

401
00:20:23,280 --> 00:20:27,360
I can remember when I was in dental school, I'm walking the same hallways that I did when

402
00:20:27,360 --> 00:20:30,840
I was, you know, 25 years old, like, right?

403
00:20:30,840 --> 00:20:32,080
So I mean, it's right.

404
00:20:32,080 --> 00:20:33,080
Yeah.

405
00:20:33,080 --> 00:20:34,080
It's crazy.

406
00:20:34,080 --> 00:20:35,080
It's crazy.

407
00:20:35,080 --> 00:20:36,640
You got your graduation picture on the wall too, right?

408
00:20:36,640 --> 00:20:37,640
Yeah.

409
00:20:37,640 --> 00:20:38,640
Behind my back.

410
00:20:38,640 --> 00:20:39,640
It's going to be all right.

411
00:20:39,640 --> 00:20:40,640
Exactly.

412
00:20:40,640 --> 00:20:41,640
And everything like that.

413
00:20:41,640 --> 00:20:43,320
And it's, yeah.

414
00:20:43,320 --> 00:20:44,840
I loved Stony Brook.

415
00:20:44,840 --> 00:20:47,400
I still love Stony Brook.

416
00:20:47,400 --> 00:20:50,640
I think it's a great program.

417
00:20:50,640 --> 00:20:54,240
You know, the faculty there are great.

418
00:20:54,240 --> 00:20:58,120
I mean, you know, I have, you know, the ones that I work with all the time.

419
00:20:58,120 --> 00:21:01,320
I just think the world of, I think they're great people and great people.

420
00:21:01,320 --> 00:21:02,320
You work with Dr. Bruthi?

421
00:21:02,320 --> 00:21:03,320
Do you know Dr. Bruthi?

422
00:21:03,320 --> 00:21:07,680
I know Dr. Bruthi never worked with him because he's usually at the hospital.

423
00:21:07,680 --> 00:21:09,200
I saw him always a couple of times.

424
00:21:09,200 --> 00:21:10,200
He might be in the hospital.

425
00:21:10,200 --> 00:21:11,200
Yeah.

426
00:21:11,200 --> 00:21:12,200
He's in the hospital a lot.

427
00:21:12,200 --> 00:21:13,480
And I'm only there Wednesday.

428
00:21:13,480 --> 00:21:16,480
So he may be in the clinic on the World Surgeon thing on different days.

429
00:21:16,480 --> 00:21:17,480
Or his office.

430
00:21:17,480 --> 00:21:19,800
He's unbelievable surgeon for sure.

431
00:21:19,800 --> 00:21:20,800
100%.

432
00:21:20,800 --> 00:21:21,800
Right.

433
00:21:21,800 --> 00:21:22,800
He's a great surgeon.

434
00:21:22,800 --> 00:21:26,880
I mean, I do see that I do work with the World Surgeon Residence a lot because being

435
00:21:26,880 --> 00:21:33,200
in the GPR, they work closely with us on certain cases and they have nothing but great

436
00:21:33,200 --> 00:21:35,880
things to say about Dr. Bruthi.

437
00:21:35,880 --> 00:21:41,280
The whole Ors surgery, attending, most of the attendings are just fantastic.

438
00:21:41,280 --> 00:21:42,780
I mean, they really are.

439
00:21:42,780 --> 00:21:47,400
And the Ors surgery residents are very good to the GPR residents.

440
00:21:47,400 --> 00:21:49,720
And they bail them out of a lot of stuff.

441
00:21:49,720 --> 00:21:51,320
They teach them a lot of stuff.

442
00:21:51,320 --> 00:22:00,960
So I mean, it's great for Ors surgery residents to bail GPR residents out because that's what

443
00:22:00,960 --> 00:22:01,960
we're going to do.

444
00:22:01,960 --> 00:22:05,120
Because it's going to be, that's what you're going to, one of the parts of being an Ors

445
00:22:05,120 --> 00:22:06,800
surgeon is that.

446
00:22:06,800 --> 00:22:10,160
So it's good for both sides.

447
00:22:10,160 --> 00:22:11,280
It's good for both.

448
00:22:11,280 --> 00:22:15,040
It's good for both sides because first of all, like whenever an Ors surgery resident comes

449
00:22:15,040 --> 00:22:19,520
over to help of GPR resident, I tell them, watch him like a log, see what he did.

450
00:22:19,520 --> 00:22:20,520
Right?

451
00:22:20,520 --> 00:22:21,520
Asking questions.

452
00:22:21,520 --> 00:22:22,520
Right.

453
00:22:22,520 --> 00:22:23,520
Right.

454
00:22:23,520 --> 00:22:24,520
Asking questions.

455
00:22:24,520 --> 00:22:26,240
Because you're learning.

456
00:22:26,240 --> 00:22:27,240
That's what I'm saying.

457
00:22:27,240 --> 00:22:28,240
You're always actively learning.

458
00:22:28,240 --> 00:22:29,240
Right?

459
00:22:29,240 --> 00:22:33,680
You know, that's part of it.

460
00:22:33,680 --> 00:22:39,200
And what bugs me out is when I'm working in the GPR and I see one of the 40 students

461
00:22:39,200 --> 00:22:44,800
that I worked with and they're about to graduate their Ors surgery residency and they're like,

462
00:22:44,800 --> 00:22:47,560
it's like a different person.

463
00:22:47,560 --> 00:22:52,200
Like they're still awesome and they're still great student, but they're just seeing how

464
00:22:52,200 --> 00:22:53,320
far they've come.

465
00:22:53,320 --> 00:22:54,320
It's unbelievable.

466
00:22:54,320 --> 00:22:55,320
Yeah.

467
00:22:55,320 --> 00:22:56,320
Yeah.

468
00:22:56,320 --> 00:23:00,640
And like even seeing my GPR residents, if the ones that stay on and put their chief here,

469
00:23:00,640 --> 00:23:03,360
if they stay on for a second, you've seen the change from them when they walked in the

470
00:23:03,360 --> 00:23:05,000
first year to when they graduate.

471
00:23:05,000 --> 00:23:06,560
It's unbelievable.

472
00:23:06,560 --> 00:23:10,440
Speaking of Nadine, one of the best friends of mine too.

473
00:23:10,440 --> 00:23:11,440
Yeah.

474
00:23:11,440 --> 00:23:12,440
She stayed for a chief here.

475
00:23:12,440 --> 00:23:13,440
She was great.

476
00:23:13,440 --> 00:23:14,440
She was great.

477
00:23:14,440 --> 00:23:15,440
She was great chief.

478
00:23:15,440 --> 00:23:16,440
Well, sure.

479
00:23:16,440 --> 00:23:17,440
And everything like that.

480
00:23:17,440 --> 00:23:18,440
I miss them all.

481
00:23:18,440 --> 00:23:21,840
I gotta tell you, they're all really, really good.

482
00:23:21,840 --> 00:23:23,960
It's sad to see them go, you know?

483
00:23:23,960 --> 00:23:24,960
Yeah.

484
00:23:24,960 --> 00:23:26,520
They get a whole new bunch of them in.

485
00:23:26,520 --> 00:23:28,520
I mean, it's like...

486
00:23:28,520 --> 00:23:31,080
Every year and that's the difference between dental school and GPR.

487
00:23:31,080 --> 00:23:35,600
I mean, you know, with GPR, you get them one year, maybe two if they stay for a chief,

488
00:23:35,600 --> 00:23:38,800
but at least in dental school, you can kind of see some in the hallways for a few years.

489
00:23:38,800 --> 00:23:39,800
Right.

490
00:23:39,800 --> 00:23:40,800
You see them in the hallway.

491
00:23:40,800 --> 00:23:41,800
I tend to only to work with the fourth year.

492
00:23:41,800 --> 00:23:44,000
You know, I only really see the fourth year.

493
00:23:44,000 --> 00:23:49,160
I once in a while, I'll have the second year in the clinic and I'll come across working

494
00:23:49,160 --> 00:23:51,760
with them just on, you know, other stuff.

495
00:23:51,760 --> 00:23:55,200
But most of the time it's just the fourth year that I work with.

496
00:23:55,200 --> 00:23:56,200
Right.

497
00:23:56,200 --> 00:23:57,200
Right.

498
00:23:57,200 --> 00:24:01,480
I think I had introduced you to Sean earlier on and also Sean apologized.

499
00:24:01,480 --> 00:24:02,480
He couldn't make it tonight.

500
00:24:02,480 --> 00:24:03,480
Of the while.

501
00:24:03,480 --> 00:24:06,760
I still see Sean walk in the hallways.

502
00:24:06,760 --> 00:24:07,760
So it's...

503
00:24:07,760 --> 00:24:08,760
Yeah.

504
00:24:08,760 --> 00:24:09,760
Yeah.

505
00:24:09,760 --> 00:24:10,760
And that's good.

506
00:24:10,760 --> 00:24:11,760
Good.

507
00:24:11,760 --> 00:24:12,760
Shawaz, I'm sorry to cut you off.

508
00:24:12,760 --> 00:24:15,440
No, no, I just said that Sean's there still.

509
00:24:15,440 --> 00:24:16,440
So...

510
00:24:16,440 --> 00:24:17,440
Yeah, absolutely.

511
00:24:17,440 --> 00:24:22,240
So, you probably want to talk about private practice though, right?

512
00:24:22,240 --> 00:24:23,240
So...

513
00:24:23,240 --> 00:24:24,240
Yeah, yeah.

514
00:24:24,240 --> 00:24:29,920
I mean, so private practice is a whole different animal than the whole teaching aspect of,

515
00:24:29,920 --> 00:24:33,200
you know, of everything.

516
00:24:33,200 --> 00:24:34,200
When you...

517
00:24:34,200 --> 00:24:40,240
Private practice is, like I said, like some people advertise, I didn't.

518
00:24:40,240 --> 00:24:46,400
The biggest thing about private practice is your skill set.

519
00:24:46,400 --> 00:24:47,400
Okay.

520
00:24:47,400 --> 00:24:48,760
And that's why I say you never stop learning.

521
00:24:48,760 --> 00:24:51,040
You should be improving your skill set and you see what you...

522
00:24:51,040 --> 00:24:53,360
And then you'll start to do treatments that you...

523
00:24:53,360 --> 00:24:54,920
You'll tend to start doing things that you like.

524
00:24:54,920 --> 00:24:56,080
You know what I'm saying?

525
00:24:56,080 --> 00:24:58,840
And private practice will kind of go that way.

526
00:24:58,840 --> 00:25:02,800
But what's really important is your staff.

527
00:25:02,800 --> 00:25:04,560
Okay.

528
00:25:04,560 --> 00:25:09,000
So staff is huge and you want to hire good people.

529
00:25:09,000 --> 00:25:10,000
And when you...

530
00:25:10,000 --> 00:25:13,480
To hire good people, you also have to pay good people and you have to pay them what they

531
00:25:13,480 --> 00:25:15,000
deserve to be paid.

532
00:25:15,000 --> 00:25:16,000
Right.

533
00:25:16,000 --> 00:25:18,400
So when I...

534
00:25:18,400 --> 00:25:23,360
So my sister is my office manager still and she's been there before I was even there.

535
00:25:23,360 --> 00:25:25,480
But she's still there.

536
00:25:25,480 --> 00:25:27,480
The two hygienists I worked...

537
00:25:27,480 --> 00:25:29,520
That worked for me stayed on.

538
00:25:29,520 --> 00:25:33,720
They both retired now and they both with me over 20 years.

539
00:25:33,720 --> 00:25:34,720
Right.

540
00:25:34,720 --> 00:25:38,520
So, I mean, when they retired, it was like heartbreaking.

541
00:25:38,520 --> 00:25:39,520
Like, you know, I mean...

542
00:25:39,520 --> 00:25:40,520
Yeah.

543
00:25:40,520 --> 00:25:41,520
Well, heartbreaking.

544
00:25:41,520 --> 00:25:45,120
But they had, you know, it's the way life works and everything like that.

545
00:25:45,120 --> 00:25:49,160
Nicole, you remember Nicole who used to work in town.

546
00:25:49,160 --> 00:25:52,520
So like, she was great.

547
00:25:52,520 --> 00:25:53,520
She was great.

548
00:25:53,520 --> 00:25:56,680
And so it was a very family-like atmosphere.

549
00:25:56,680 --> 00:26:03,240
So as a dentist, you have to hire good people and have good systems in place.

550
00:26:03,240 --> 00:26:04,560
Okay.

551
00:26:04,560 --> 00:26:05,840
And be good to those people.

552
00:26:05,840 --> 00:26:06,840
Right.

553
00:26:06,840 --> 00:26:07,840
Okay.

554
00:26:07,840 --> 00:26:10,240
Because when you're good to people, they're gonna be good back to you generally.

555
00:26:10,240 --> 00:26:11,240
Okay.

556
00:26:11,240 --> 00:26:12,600
And if they're not, then you know what?

557
00:26:12,600 --> 00:26:15,560
You did the right thing and then you moved past it.

558
00:26:15,560 --> 00:26:17,440
But that's a big thing.

559
00:26:17,440 --> 00:26:18,440
You have to be...

560
00:26:18,440 --> 00:26:20,240
You have to have a great staff.

561
00:26:20,240 --> 00:26:23,480
You have to train them to do how you want to practice.

562
00:26:23,480 --> 00:26:24,800
But you have to be good to them.

563
00:26:24,800 --> 00:26:26,800
You have to be good to them.

564
00:26:26,800 --> 00:26:27,800
What are some ways...

565
00:26:27,800 --> 00:26:31,080
Because, I mean, well, the hospital is different, right?

566
00:26:31,080 --> 00:26:33,520
No one's getting a good paycheck there.

567
00:26:33,520 --> 00:26:40,120
But what are some ways, other than financial reimbursement, salaries, etc., to kind of keep

568
00:26:40,120 --> 00:26:44,320
so unmotivated, being good to someone on the team?

569
00:26:44,320 --> 00:26:45,760
It's not even about being an employee.

570
00:26:45,760 --> 00:26:47,640
It's about someone on your team, right?

571
00:26:47,640 --> 00:26:53,320
What's one way, other than like, you know, the salary or financials, to kind of keep

572
00:26:53,320 --> 00:26:56,160
so unmotivated, keep them on the team and you know what I mean?

573
00:26:56,160 --> 00:26:59,760
Well, at least once every three months, we do happy hours.

574
00:26:59,760 --> 00:27:03,160
We go out as an office, right?

575
00:27:03,160 --> 00:27:08,600
And not really be like in the whole dental environment and like happy hour.

576
00:27:08,600 --> 00:27:12,360
You do that, you get involved with there.

577
00:27:12,360 --> 00:27:13,360
You get in contact.

578
00:27:13,360 --> 00:27:18,880
You just got to be in touch with their families and like and care about them as a person.

579
00:27:18,880 --> 00:27:20,720
I think that's the real thing.

580
00:27:20,720 --> 00:27:25,120
You have to make that connection with them in a personal level, right?

581
00:27:25,120 --> 00:27:27,400
You know, and everything like that.

582
00:27:27,400 --> 00:27:31,120
You have to make it a fun work environment, not so serious all the time.

583
00:27:31,120 --> 00:27:33,120
It doesn't have to be so serious all the time.

584
00:27:33,120 --> 00:27:37,420
You know, patients like when you walk, when they walk into an office and the whole feeling

585
00:27:37,420 --> 00:27:39,040
is a relaxed feel.

586
00:27:39,040 --> 00:27:40,040
Yeah, yeah.

587
00:27:40,040 --> 00:27:41,040
Right?

588
00:27:41,040 --> 00:27:45,640
If it's ultra uptight and like, you know, then that's not that's not a really good, the

589
00:27:45,640 --> 00:27:47,280
patients could pick up on that.

590
00:27:47,280 --> 00:27:48,280
Okay.

591
00:27:48,280 --> 00:27:52,520
I know dentists who like big bread in their office to get that just a different smell

592
00:27:52,520 --> 00:27:53,520
in the office.

593
00:27:53,520 --> 00:27:55,040
I mean, I'm not kidding.

594
00:27:55,040 --> 00:27:58,200
I know what the dentist does that and it's not a bad, yeah, right?

595
00:27:58,200 --> 00:28:03,400
It's not a bad idea because you like it brings like a home feel to it and stuff like that.

596
00:28:03,400 --> 00:28:04,400
There's a whole different ways.

597
00:28:04,400 --> 00:28:08,800
But to keep your staff happy, you have to interact with them.

598
00:28:08,800 --> 00:28:10,640
You have to hold them accountable for the document.

599
00:28:10,640 --> 00:28:13,800
You have to hold them accountable for when things aren't right.

600
00:28:13,800 --> 00:28:16,360
But I got to tell you, so you lead by example.

601
00:28:16,360 --> 00:28:18,840
I mean, so I mean, that's basically what it is.

602
00:28:18,840 --> 00:28:23,440
I mean, like, if you hold yourself accountable for certain things that your staff will tend

603
00:28:23,440 --> 00:28:26,120
to hold themselves accountable.

604
00:28:26,120 --> 00:28:29,720
But if you did something wrong and we all do something wrong and you don't take accountability

605
00:28:29,720 --> 00:28:37,800
for it, then you're not showing them the right way to do, right?

606
00:28:37,800 --> 00:28:40,960
You know, leaders don't tell people what to do.

607
00:28:40,960 --> 00:28:44,240
Leaders act and show them how to do it.

608
00:28:44,240 --> 00:28:46,520
Like what I'm not, that's basically what it is.

609
00:28:46,520 --> 00:28:49,240
So like, you lead by example.

610
00:28:49,240 --> 00:28:52,400
And I think that's really the way it is.

611
00:28:52,400 --> 00:28:57,260
So when a dentist is relaxed, the staff tends to be relaxed.

612
00:28:57,260 --> 00:28:59,960
So I used to always say to myself, I set the tone.

613
00:28:59,960 --> 00:29:04,680
Like so like, if I walk in there in a bad mood, everybody's day is going to be in a

614
00:29:04,680 --> 00:29:07,200
bad mood.

615
00:29:07,200 --> 00:29:09,920
I'm not a yellower, but if I'm quiet, I get quiet.

616
00:29:09,920 --> 00:29:13,920
When I'm annoyed or upset, I get quiet.

617
00:29:13,920 --> 00:29:18,840
And they used to know if I'm quiet, something's like I'm upset about something.

618
00:29:18,840 --> 00:29:22,520
I'm not detected just start screaming through the office and stuff like that.

619
00:29:22,520 --> 00:29:23,840
But like, right, right.

620
00:29:23,840 --> 00:29:27,960
And so it's all made to set the tone, right?

621
00:29:27,960 --> 00:29:32,160
You know, were there a lot of quiet days in those, those two years when you were the

622
00:29:32,160 --> 00:29:33,160
sole partner?

623
00:29:33,160 --> 00:29:42,640
The, uh, so, you know, I got to tell you, there, there was, it was definitely more stressful.

624
00:29:42,640 --> 00:29:47,360
Um, stress, like everybody handles stress in different ways.

625
00:29:47,360 --> 00:29:52,520
Uh, there was, there was definitely some tougher days, but I still enjoyed it.

626
00:29:52,520 --> 00:29:54,800
I look at, you know, and everything like that.

627
00:29:54,800 --> 00:29:58,080
And when you have a good staff, they help take the pressure off you.

628
00:29:58,080 --> 00:29:59,080
Right.

629
00:29:59,080 --> 00:30:00,080
Right.

630
00:30:00,080 --> 00:30:01,080
And stuff like that.

631
00:30:01,080 --> 00:30:03,360
So I mean, you know, that that they're physically doing the work for you, but like, you know,

632
00:30:03,360 --> 00:30:07,520
it's, it's, you know, it's something you got, you know, it's good to be busy, like

633
00:30:07,520 --> 00:30:10,360
I said, but you don't want to be unproductive with busy.

634
00:30:10,360 --> 00:30:11,360
Right.

635
00:30:11,360 --> 00:30:12,360
Right.

636
00:30:12,360 --> 00:30:15,000
You want to be always productive and you want to be, you want every patient to have

637
00:30:15,000 --> 00:30:19,520
your full attention and you want them to, you know, and everything like that.

638
00:30:19,520 --> 00:30:23,560
And sometimes when you're over busy, you're getting pulled in so many directions, it's

639
00:30:23,560 --> 00:30:27,000
hard to pay, you want to pay attention to detail, you want to pay, you know, and, and,

640
00:30:27,000 --> 00:30:29,680
and that can get tough and that can get tough.

641
00:30:29,680 --> 00:30:32,160
So that's what, that's what I did not like about it.

642
00:30:32,160 --> 00:30:35,800
That's the only thing I didn't, the only thing I didn't like about it is like, I, I just

643
00:30:35,800 --> 00:30:40,120
felt I wasn't spending enough time.

644
00:30:40,120 --> 00:30:41,720
And that's, that's, that's my fault.

645
00:30:41,720 --> 00:30:42,720
And that's the accountability.

646
00:30:42,720 --> 00:30:43,720
Right.

647
00:30:43,720 --> 00:30:46,240
So that like, that's where I struggle.

648
00:30:46,240 --> 00:30:47,240
That's what I,

649
00:30:47,240 --> 00:30:52,160
And you mentioned earlier, not enough time with patients in some circumstances, right?

650
00:30:52,160 --> 00:30:57,120
What about time with employees, with that kind of fall into the umbrella too?

651
00:30:57,120 --> 00:31:01,720
Or team, you know, nonemployee bill, like your team.

652
00:31:01,720 --> 00:31:04,840
So, you know, everybody kind of worked together.

653
00:31:04,840 --> 00:31:09,240
So like, you know, it's a, you saw my office is not very big, you know, and that's what

654
00:31:09,240 --> 00:31:10,240
I mean.

655
00:31:10,240 --> 00:31:11,240
Everybody was around each other.

656
00:31:11,240 --> 00:31:15,400
So there was always time that we were talking or something is happening.

657
00:31:15,400 --> 00:31:22,040
The hardest part is keeping the staff nice to each other.

658
00:31:22,040 --> 00:31:23,760
Is that so much nice to me, right?

659
00:31:23,760 --> 00:31:26,920
Like, how often politics go?

660
00:31:26,920 --> 00:31:31,480
Like, you know, this one's mad about this cause she did this and then like, you know,

661
00:31:31,480 --> 00:31:35,600
that, I mean, so that stuff, stuff that like, you need a good office manager to be able

662
00:31:35,600 --> 00:31:39,200
to keep them back on track and stuff like that.

663
00:31:39,200 --> 00:31:40,200
And they, like,

664
00:31:40,200 --> 00:31:41,200
They're leverage.

665
00:31:41,200 --> 00:31:42,200
Right.

666
00:31:42,200 --> 00:31:47,320
I was going to say, Siraj, one of the first things that Dr. Kasha taught me, it was at

667
00:31:47,320 --> 00:31:49,320
the gym, it was a Sunday morning.

668
00:31:49,320 --> 00:31:52,880
This is, this is while I was in undergrad, right?

669
00:31:52,880 --> 00:31:54,680
And I was like, how's everything going?

670
00:31:54,680 --> 00:32:01,000
And he's like, you know, when you really boil it down, I'm just a firefighter all day.

671
00:32:01,000 --> 00:32:02,720
I'm just putting out fires.

672
00:32:02,720 --> 00:32:05,680
And I was like, I didn't really understand at the time as though, I guess, you know,

673
00:32:05,680 --> 00:32:07,200
busy, a lot of stuff going on.

674
00:32:07,200 --> 00:32:09,160
And now, and now I know.

675
00:32:09,160 --> 00:32:10,160
You know, right?

676
00:32:10,160 --> 00:32:15,640
And I mean, like, so what happens is, the longer you're in practice, the more patients

677
00:32:15,640 --> 00:32:18,480
you have treated, right?

678
00:32:18,480 --> 00:32:24,480
The more, I mean, I could see it all of a sudden, I'll see a patient that I treated 10 years

679
00:32:24,480 --> 00:32:26,560
ago, and I haven't seen them.

680
00:32:26,560 --> 00:32:28,680
And now they're having a problem.

681
00:32:28,680 --> 00:32:29,680
Right.

682
00:32:29,680 --> 00:32:33,160
And it's like, you know, and so, I mean, that's the whole thing.

683
00:32:33,160 --> 00:32:37,920
So now you have to squeeze this into where you're doing this and stuff like that.

684
00:32:37,920 --> 00:32:45,400
If it's a real emergency, like, you know, and stuff like that, you know, it's funny.

685
00:32:45,400 --> 00:32:47,800
Like I always have something I have to my office.

686
00:32:47,800 --> 00:32:49,160
I should take a picture of it in shorts here.

687
00:32:49,160 --> 00:32:52,320
It says, what does it say?

688
00:32:52,320 --> 00:32:53,320
It's something funny.

689
00:32:53,320 --> 00:33:00,560
It says, procrastination on your part is not an emergency on my part.

690
00:33:00,560 --> 00:33:01,960
But I didn't say it to a patient.

691
00:33:01,960 --> 00:33:03,960
No, but I always say that it calms me down.

692
00:33:03,960 --> 00:33:04,960
Okay.

693
00:33:04,960 --> 00:33:07,560
So listen, it's like, because them just want to blame themselves for everything.

694
00:33:07,560 --> 00:33:08,960
I don't know where we learned this.

695
00:33:08,960 --> 00:33:13,200
But like, you know, you got a case that you did 15 years ago and if something's going

696
00:33:13,200 --> 00:33:15,960
bad with the case, you feel bad, right?

697
00:33:15,960 --> 00:33:16,960
You feel bad, right?

698
00:33:16,960 --> 00:33:18,960
And it's like, it's not your fault.

699
00:33:18,960 --> 00:33:22,720
I mean, things what God gave them didn't work full time.

700
00:33:22,720 --> 00:33:23,720
Right.

701
00:33:23,720 --> 00:33:26,560
So in New York, you know, and we're not God, like, you know, and everything like that.

702
00:33:26,560 --> 00:33:30,680
But it's, so, I mean, that's, so you would never, I would never say it to a patient.

703
00:33:30,680 --> 00:33:31,680
Right.

704
00:33:31,680 --> 00:33:32,680
You wouldn't say that to a patient.

705
00:33:32,680 --> 00:33:35,560
I say it to patients, not that, but I say to a patient all the time.

706
00:33:35,560 --> 00:33:39,120
And I was like, so when was the last time you saw a dentist?

707
00:33:39,120 --> 00:33:41,800
And it's like, well, you know, COVID happened.

708
00:33:41,800 --> 00:33:44,080
And I was like, okay, let's type of for COVID.

709
00:33:44,080 --> 00:33:47,920
And they're like, well, I, I don't know, you know, the recession happened.

710
00:33:47,920 --> 00:33:49,680
They way never better than that.

711
00:33:49,680 --> 00:33:50,960
Yeah, no, it's, it's true.

712
00:33:50,960 --> 00:33:51,960
It's true.

713
00:33:51,960 --> 00:33:57,240
You know, people, people don't take care, a lot of people don't take care of their

714
00:33:57,240 --> 00:33:58,240
teeth.

715
00:33:58,240 --> 00:33:59,240
We see it all the time, right?

716
00:33:59,240 --> 00:34:01,840
They don't take, they don't take care of their teeth.

717
00:34:01,840 --> 00:34:04,400
And they get themselves in a lot of trouble for not doing that.

718
00:34:04,400 --> 00:34:10,280
I mean, like, you know, you know, facial swellings and big, big time stuff that can go wrong.

719
00:34:10,280 --> 00:34:15,280
Or like usually, you know, one of the big things when you're doing a case, like say

720
00:34:15,280 --> 00:34:19,000
we're doing a big crime of ridge case, you have to take in account the patient's hygiene,

721
00:34:19,000 --> 00:34:20,360
because they have to maintain this.

722
00:34:20,360 --> 00:34:24,360
If they, if they're not maintaining my big thing that I say to them, and I will say this

723
00:34:24,360 --> 00:34:27,760
is I get to see you every six months.

724
00:34:27,760 --> 00:34:28,760
Right.

725
00:34:28,760 --> 00:34:31,680
And they clean your teeth every six months.

726
00:34:31,680 --> 00:34:33,640
You have to clean your teeth every day.

727
00:34:33,640 --> 00:34:34,640
In between those six months.

728
00:34:34,640 --> 00:34:35,640
Right.

729
00:34:35,640 --> 00:34:36,640
Every three months.

730
00:34:36,640 --> 00:34:39,840
So like, you're, you're, I need your help to maintain this.

731
00:34:39,840 --> 00:34:40,840
Right.

732
00:34:40,840 --> 00:34:43,520
You know, basically what, what if I'm sound to?

733
00:34:43,520 --> 00:34:44,520
You can help?

734
00:34:44,520 --> 00:34:45,520
Yeah.

735
00:34:45,520 --> 00:34:46,520
It's hard.

736
00:34:46,520 --> 00:34:48,560
Changing people's habits is hard.

737
00:34:48,560 --> 00:34:50,480
You know, and stuff like that.

738
00:34:50,480 --> 00:34:51,480
That's a hard thing to do.

739
00:34:51,480 --> 00:34:55,600
You know, patient come in and like, you know, you took out, you took out a wisdom tooth.

740
00:34:55,600 --> 00:34:56,600
They get a dry socket.

741
00:34:56,600 --> 00:34:57,600
Did you smoke?

742
00:34:57,600 --> 00:34:58,600
Yes.

743
00:34:58,600 --> 00:34:59,600
Did I tell you not to smoke?

744
00:34:59,600 --> 00:35:00,600
Yes.

745
00:35:00,600 --> 00:35:01,600
I can't.

746
00:35:01,600 --> 00:35:02,600
Okay.

747
00:35:02,600 --> 00:35:04,560
I mean, that's it.

748
00:35:04,560 --> 00:35:10,680
So that's like, you know, that's like 50% your guys's job, 50% of the patient, right?

749
00:35:10,680 --> 00:35:11,680
Right.

750
00:35:11,680 --> 00:35:12,680
It's so immediate.

751
00:35:12,680 --> 00:35:15,760
So at our office, we do all the birth surgeries, which I'm pretty sure you're in labor with

752
00:35:15,760 --> 00:35:20,200
or so, like coming in like every six months for like a implant maintenance treatment.

753
00:35:20,200 --> 00:35:22,360
And like, sometimes patients will come in.

754
00:35:22,360 --> 00:35:25,120
They just don't, they haven't taken care of it.

755
00:35:25,120 --> 00:35:26,120
Their bridges are all yellow.

756
00:35:26,120 --> 00:35:27,720
They're just, it just smells like smoke.

757
00:35:27,720 --> 00:35:28,720
Right.

758
00:35:28,720 --> 00:35:31,240
Well, you know, docs just like, come on, man, what's going on?

759
00:35:31,240 --> 00:35:32,240
Yeah.

760
00:35:32,240 --> 00:35:34,960
It's a point in other dollar investment for yourself.

761
00:35:34,960 --> 00:35:35,960
Right.

762
00:35:35,960 --> 00:35:36,960
It's frustrating.

763
00:35:36,960 --> 00:35:37,960
It's definitely frustrating.

764
00:35:37,960 --> 00:35:43,640
It's the hardest thing to do is to break people's habits.

765
00:35:43,640 --> 00:35:44,920
You know, a lot of it.

766
00:35:44,920 --> 00:35:50,600
So the whole on four is interesting and not to digress on this.

767
00:35:50,600 --> 00:35:51,600
I'm bad.

768
00:35:51,600 --> 00:35:54,280
So all on four, I don't do hybrid anymore.

769
00:35:54,280 --> 00:35:57,080
I don't do acrylic.

770
00:35:57,080 --> 00:36:00,280
I do mostly zirconia or PFN.

771
00:36:00,280 --> 00:36:05,400
And the reason why is because everything sticks to zirconia, to acrylic.

772
00:36:05,400 --> 00:36:06,400
Okay.

773
00:36:06,400 --> 00:36:07,720
Everything sticks to it.

774
00:36:07,720 --> 00:36:09,000
It gets nasty looking.

775
00:36:09,000 --> 00:36:10,480
It gets melty.

776
00:36:10,480 --> 00:36:15,320
It just gets like, you know, it's just not, it's so zirconia, especially everything

777
00:36:15,320 --> 00:36:17,440
just falls away from zirconia.

778
00:36:17,440 --> 00:36:19,240
Things don't stick to zirconia.

779
00:36:19,240 --> 00:36:20,920
They don't stick to it.

780
00:36:20,920 --> 00:36:27,800
So you'll see that, you know, zirconia is easier to clean.

781
00:36:27,800 --> 00:36:31,520
Like there's not as much sticking to it, there's no staining that you see with the acrylic.

782
00:36:31,520 --> 00:36:32,520
Okay.

783
00:36:32,520 --> 00:36:35,480
If you have a smoke and you do an acrylic hybrid, it's stained within a year.

784
00:36:35,480 --> 00:36:38,040
It's stained and looks gross.

785
00:36:38,040 --> 00:36:44,200
You don't deal with as many broken teeth, broken appliances, but where's the weak link?

786
00:36:44,200 --> 00:36:46,600
This is something that we all talk about.

787
00:36:46,600 --> 00:36:50,840
So a lot of the docs that do full arch like myself, one of our big discussions that we

788
00:36:50,840 --> 00:36:56,560
have is a lot of times I go with zirconia or PFM, but here's the thing with all on four

789
00:36:56,560 --> 00:36:57,560
or full arch.

790
00:36:57,560 --> 00:36:59,760
I don't really consider all on four.

791
00:36:59,760 --> 00:37:03,400
I consider it all on whatever it takes.

792
00:37:03,400 --> 00:37:10,960
But the zirconia is strong, very strong.

793
00:37:10,960 --> 00:37:13,880
So especially monolithic zirconia, right?

794
00:37:13,880 --> 00:37:17,760
So we're not doing porcelain, fuses, zirconia or something like that.

795
00:37:17,760 --> 00:37:19,840
So where's the weak link?

796
00:37:19,840 --> 00:37:24,520
What's great about acrylic is they implant, 10 won't get overloaded, 10 not to get overloaded

797
00:37:24,520 --> 00:37:29,400
because the acrylic will break or the acrylic.

798
00:37:29,400 --> 00:37:36,800
So we always, so these long, these cases I'm interested to see long term what's going to

799
00:37:36,800 --> 00:37:37,800
happen.

800
00:37:37,800 --> 00:37:40,200
So where is the weak link?

801
00:37:40,200 --> 00:37:41,640
It could be a prosthetic screw.

802
00:37:41,640 --> 00:37:43,760
It could be an abutment screw.

803
00:37:43,760 --> 00:37:48,640
It could be, God forbid, the implant loses bone around or certain implant loses bone around

804
00:37:48,640 --> 00:37:49,640
it.

805
00:37:49,640 --> 00:37:53,760
So there's always going to be a weak link somewhere.

806
00:37:53,760 --> 00:37:59,600
And that's the biggest thing that with these all on four cases or these full arch cases

807
00:37:59,600 --> 00:38:00,800
is occlusion.

808
00:38:00,800 --> 00:38:06,880
I say this all the time and passive fit of the prosthetic.

809
00:38:06,880 --> 00:38:07,880
That's it.

810
00:38:07,880 --> 00:38:08,880
Passive fit.

811
00:38:08,880 --> 00:38:09,880
I'm still worrying about that.

812
00:38:09,880 --> 00:38:11,840
What do you mean by passive fit?

813
00:38:11,840 --> 00:38:18,000
So when you're doing a, so I mean I can get on to this is prosthetics like big time prosthetics

814
00:38:18,000 --> 00:38:19,000
that we're talking about.

815
00:38:19,000 --> 00:38:26,320
So passive fit is so when you have implants splinted together, the appliance fits on them

816
00:38:26,320 --> 00:38:30,000
and fully fits on it passively.

817
00:38:30,000 --> 00:38:32,720
You should be able to just drop it on it as it seats.

818
00:38:32,720 --> 00:38:33,720
Oh, okay.

819
00:38:33,720 --> 00:38:35,720
You could go rock.

820
00:38:35,720 --> 00:38:39,280
There's no kind of the screws aren't tight going in.

821
00:38:39,280 --> 00:38:42,240
So like right, so you got forces from occlusion.

822
00:38:42,240 --> 00:38:46,880
But if you have an appliance that you squeezed on, you're putting pressure on those implants

823
00:38:46,880 --> 00:38:47,880
internally.

824
00:38:47,880 --> 00:38:49,880
That's right.

825
00:38:49,880 --> 00:38:50,880
So what happens?

826
00:38:50,880 --> 00:38:54,480
So like I like to say, what happens in ortho like when you put pressure on a tooth, bone

827
00:38:54,480 --> 00:38:56,400
source to remodel, right?

828
00:38:56,400 --> 00:38:58,200
And then the penis moves.

829
00:38:58,200 --> 00:39:00,080
Well implants don't want to move, right?

830
00:39:00,080 --> 00:39:05,080
So if you get bone remodeling around an implant or like if you have constant pressure in that

831
00:39:05,080 --> 00:39:09,240
area that that in around an implant, it's going to lose bone around.

832
00:39:09,240 --> 00:39:10,240
That's sort of the solution.

833
00:39:10,240 --> 00:39:11,240
Yeah.

834
00:39:11,240 --> 00:39:15,840
So I mean that's that's so you want passive fit appliances and it's hard sometimes.

835
00:39:15,840 --> 00:39:19,160
The more implants that you're trying to connect together, the harder it is.

836
00:39:19,160 --> 00:39:23,920
So do you do like our office we do temporary acrylics and then you actually go to the finals

837
00:39:23,920 --> 00:39:25,640
out kind of what you do?

838
00:39:25,640 --> 00:39:26,640
Yes.

839
00:39:26,640 --> 00:39:27,640
Yes.

840
00:39:27,640 --> 00:39:32,440
And then even when I'm making the finals, your calling in case I go to a prototype PMMA

841
00:39:32,440 --> 00:39:37,160
that I let the patient wear for a couple of weeks before I copy Miller and you should

842
00:39:37,160 --> 00:39:40,240
call me and stuff like that.

843
00:39:40,240 --> 00:39:45,120
So I mean, it's great because you get they get to test drive it, right?

844
00:39:45,120 --> 00:39:48,800
And then you've got any chance changes you want to make you want to make in the PMMA

845
00:39:48,800 --> 00:39:50,880
provision, right?

846
00:39:50,880 --> 00:39:54,240
And then what happens is you take that temporary away from the patient, usually have the other

847
00:39:54,240 --> 00:39:58,800
temporary that you put them back in and then you put that on the master model and then

848
00:39:58,800 --> 00:40:02,640
they copy Miller at the lab in Zirconia.

849
00:40:02,640 --> 00:40:03,640
Right.

850
00:40:03,640 --> 00:40:07,520
Do you want to sit with the Zirconia final like trimming it away and putting the bi-paper

851
00:40:07,520 --> 00:40:09,520
and trying to figure in that like.

852
00:40:09,520 --> 00:40:13,000
Even when they copy Miller, you always go back to occlusion and occlusion still always has

853
00:40:13,000 --> 00:40:18,760
to be modified a little bit 100%, but it's so hard to draw a Zirconia strung.

854
00:40:18,760 --> 00:40:21,880
You want to touch the final product as little as possible.

855
00:40:21,880 --> 00:40:24,320
You know, I mean 100%.

856
00:40:24,320 --> 00:40:27,080
And so I mean, that's how it is.

857
00:40:27,080 --> 00:40:33,120
But I mean, we talk TMJ, you could talk about passive fitter down implants for like, I mean,

858
00:40:33,120 --> 00:40:35,680
we can talk about it for hours.

859
00:40:35,680 --> 00:40:38,720
You know, it's a lot.

860
00:40:38,720 --> 00:40:39,720
It's a lot.

861
00:40:39,720 --> 00:40:40,720
Actually, that talk about.

862
00:40:40,720 --> 00:40:44,320
You talk about verified impressions, you got to get a verified impression.

863
00:40:44,320 --> 00:40:47,400
You know, so like people are a lot people who don't get a verified impression.

864
00:40:47,400 --> 00:40:52,440
It's like, so I mean, there's certain things that go into it.

865
00:40:52,440 --> 00:40:56,200
I'm interested where how CADCAM is coming along with it, like, you know, with, you know,

866
00:40:56,200 --> 00:41:01,240
digital dentistry and stuff like that, you know, with the accuracy and everything like

867
00:41:01,240 --> 00:41:02,240
that.

868
00:41:02,240 --> 00:41:07,360
So, you know, dentistry is changing and systems are getting quicker, which is great.

869
00:41:07,360 --> 00:41:11,280
But you know, you still have to, I think still have to fit.

870
00:41:11,280 --> 00:41:12,880
You know, they have to fit.

871
00:41:12,880 --> 00:41:17,720
You know, I'm at the VA right now where it's very heavy for implants because, you know,

872
00:41:17,720 --> 00:41:19,200
the VA covers a lot of that.

873
00:41:19,200 --> 00:41:24,120
And what I like most about the VA is not only that, which is great training.

874
00:41:24,120 --> 00:41:26,360
We have a new attending over there that's fantastic.

875
00:41:26,360 --> 00:41:27,920
We do all on X cases.

876
00:41:27,920 --> 00:41:30,160
We don't bore now all on fives.

877
00:41:30,160 --> 00:41:34,360
And one of them was two of that.

878
00:41:34,360 --> 00:41:35,360
One of them was guided.

879
00:41:35,360 --> 00:41:36,360
It was great.

880
00:41:36,360 --> 00:41:40,840
What's great is that in the clinic at the dental clinic at the VA, we're in the oral

881
00:41:40,840 --> 00:41:42,920
surgery, but then down the whole process.

882
00:41:42,920 --> 00:41:47,160
So we just go walk down the hall and talk with Prost and EPR down the hall the other

883
00:41:47,160 --> 00:41:49,960
way, perio, endo.

884
00:41:49,960 --> 00:41:52,520
It's not something I have at any other facility.

885
00:41:52,520 --> 00:41:54,920
And that's what we, exactly how we could talk about.

886
00:41:54,920 --> 00:41:57,160
And so what you say is everything comes down to occlusion.

887
00:41:57,160 --> 00:42:02,880
I could actually learn from the Prostadontis because what I'm trying to learn that I don't

888
00:42:02,880 --> 00:42:08,240
get when I'm at other facilities is I work for you, the Prostadontis, right?

889
00:42:08,240 --> 00:42:09,240
Not you work for me.

890
00:42:09,240 --> 00:42:10,640
You send me where I do some implants.

891
00:42:10,640 --> 00:42:14,560
No, no, no, I need to know how to put implants in according to how you're going to make the

892
00:42:14,560 --> 00:42:18,640
occlusion, the restoration, the MIO.

893
00:42:18,640 --> 00:42:20,440
That's I wish I had more time there.

894
00:42:20,440 --> 00:42:25,160
So implants should not be, so everybody used to use the word prosthetically driven implants

895
00:42:25,160 --> 00:42:26,720
should be placed prosthetically driven.

896
00:42:26,720 --> 00:42:27,960
It's not really accurate.

897
00:42:27,960 --> 00:42:29,560
It's prosthetically referenced.

898
00:42:29,560 --> 00:42:30,640
Okay.

899
00:42:30,640 --> 00:42:37,960
Because you can't put implants, you can't put implants where the bone isn't, right?

900
00:42:37,960 --> 00:42:41,200
So you guys are, your hands are tied to a certain extent, especially in a maxillary

901
00:42:41,200 --> 00:42:43,000
anterior.

902
00:42:43,000 --> 00:42:48,640
And sometimes you have to build the bone just to put it, you know, close to the right spot.

903
00:42:48,640 --> 00:42:52,120
You know, it's, so it's always prosthetically referenced.

904
00:42:52,120 --> 00:42:56,480
It should be, especially these, especially it's going to be an all white case.

905
00:42:56,480 --> 00:42:57,480
Okay.

906
00:42:57,480 --> 00:42:58,480
All right.

907
00:42:58,480 --> 00:43:01,080
Here we go, I'm going to get on my soapbox for a second.

908
00:43:01,080 --> 00:43:07,200
So we have these all on X cases and they're great and everything like that.

909
00:43:07,200 --> 00:43:11,240
I really think that we should get away from lacking so much bone away.

910
00:43:11,240 --> 00:43:12,240
Really?

911
00:43:12,240 --> 00:43:13,240
You think so?

912
00:43:13,240 --> 00:43:16,000
Cause I'm just learning about the bone reduction, especially in the mannable.

913
00:43:16,000 --> 00:43:17,000
You need the bone right.

914
00:43:17,000 --> 00:43:21,080
So the whole thing is I have problems with that.

915
00:43:21,080 --> 00:43:25,920
So when you do, when you lack the bone away and you're, you're taking a patient that's

916
00:43:25,920 --> 00:43:30,480
an FP1 where they have, you know, an FP1, have you heard FP1?

917
00:43:30,480 --> 00:43:33,760
So FP1 is where their teeth are of normal size, right?

918
00:43:33,760 --> 00:43:36,400
FP2, the teeth look a little longer.

919
00:43:36,400 --> 00:43:38,160
And now FP3 is where there's pink.

920
00:43:38,160 --> 00:43:40,200
You need both pink and teeth, right?

921
00:43:40,200 --> 00:43:41,200
Yes.

922
00:43:41,200 --> 00:43:42,200
Okay.

923
00:43:42,200 --> 00:43:50,480
So taking an FP1 patient and turning them into an FP3 patient, is that really doing

924
00:43:50,480 --> 00:43:52,400
a lot of service for the patient?

925
00:43:52,400 --> 00:43:53,400
Right.

926
00:43:53,400 --> 00:43:54,400
Right.

927
00:43:54,400 --> 00:43:56,600
So with those implants fail, what do we got?

928
00:43:56,600 --> 00:43:57,600
We got nothing left.

929
00:43:57,600 --> 00:43:58,600
Right.

930
00:43:58,600 --> 00:44:00,600
We got to talk about zygomas, what are we talking about?

931
00:44:00,600 --> 00:44:02,920
We have to do zygoma implants.

932
00:44:02,920 --> 00:44:11,440
And so you can do a good restoration and keep an FP1, but your implants have to be critically

933
00:44:11,440 --> 00:44:12,440
placed.

934
00:44:12,440 --> 00:44:15,120
They have to be where the tooth is supposed to be.

935
00:44:15,120 --> 00:44:17,400
It means you'll just leave buckling or.

936
00:44:17,400 --> 00:44:18,400
Right.

937
00:44:18,400 --> 00:44:22,760
Cause you can't put a multi unit on it because you don't have the space for the multi unit.

938
00:44:22,760 --> 00:44:23,760
Right?

939
00:44:23,760 --> 00:44:28,040
Cause the reason why you're whacking on our bone is to create space for the appliance.

940
00:44:28,040 --> 00:44:29,040
Right?

941
00:44:29,040 --> 00:44:30,040
Right.

942
00:44:30,040 --> 00:44:32,280
Minimum of 15 millimeters that you need.

943
00:44:32,280 --> 00:44:33,280
Right?

944
00:44:33,280 --> 00:44:36,480
Basically what you guys learned.

945
00:44:36,480 --> 00:44:38,120
But we can talk about this forever.

946
00:44:38,120 --> 00:44:39,280
It'll have to be a different topic.

947
00:44:39,280 --> 00:44:40,280
Cause like.

948
00:44:40,280 --> 00:44:44,120
Actually, I was going to say that, Siraj, this is actually an excellent introduction into

949
00:44:44,120 --> 00:44:45,120
the next topic.

950
00:44:45,120 --> 00:44:50,440
Dr. Kashel, maybe we could even bring on the, I would say, who would you, who do you do

951
00:44:50,440 --> 00:44:53,840
all on X cases with like predominantly?

952
00:44:53,840 --> 00:45:01,240
So I do probably with Dr. Kebluanam, but I do do them with Dr. Gish and stuff like that.

953
00:45:01,240 --> 00:45:03,120
And stuff like that.

954
00:45:03,120 --> 00:45:07,560
Those are the two surgeons that I do most of my own X, you know, on.

955
00:45:07,560 --> 00:45:08,560
Yeah.

956
00:45:08,560 --> 00:45:10,840
We could talk about like cases and stuff one day if you want, like, you know, if you have

957
00:45:10,840 --> 00:45:12,560
pictures and stuff or, you know.

958
00:45:12,560 --> 00:45:13,560
Yeah.

959
00:45:13,560 --> 00:45:16,240
And so I mean, it's a great, it's, you know, this, this is the hot topic, right?

960
00:45:16,240 --> 00:45:19,120
I mean, this is whether you, you know, this, you, you see all the commercials.

961
00:45:19,120 --> 00:45:21,040
This is the, the, the hot thing.

962
00:45:21,040 --> 00:45:25,560
But so I had a pros and dollars who taught me and he said, it makes no sense whacking

963
00:45:25,560 --> 00:45:27,720
me all this bone and understand.

964
00:45:27,720 --> 00:45:29,120
So a patient loses a tooth.

965
00:45:29,120 --> 00:45:30,120
What do you do?

966
00:45:30,120 --> 00:45:33,280
You take the tooth out, you put an implant in, you didn't whack away any ball, right?

967
00:45:33,280 --> 00:45:34,520
Now they lose the tooth next to it.

968
00:45:34,520 --> 00:45:35,520
What do we do?

969
00:45:35,520 --> 00:45:38,520
We take out the tooth, we put the implant in, we didn't whack away any ball.

970
00:45:38,520 --> 00:45:40,840
We're keeping the architecture of the patient, right?

971
00:45:40,840 --> 00:45:41,840
Right.

972
00:45:41,840 --> 00:45:42,840
I keep me rethink.

973
00:45:42,840 --> 00:45:46,200
You just take a 40 year old patient and you whack away all this bone and they'll give

974
00:45:46,200 --> 00:45:47,200
you a role.

975
00:45:47,200 --> 00:45:48,200
I've done it.

976
00:45:48,200 --> 00:45:49,200
I'm guilty of it.

977
00:45:49,200 --> 00:45:53,720
I did like, I'm not saying I'm not, I'm not, you know, I, but I'm, as I'm looking back,

978
00:45:53,720 --> 00:45:57,400
I'm saying, are we creating dental triples in the future?

979
00:45:57,400 --> 00:46:00,480
Because if the case fails in 20 years, what do we have left?

980
00:46:00,480 --> 00:46:02,560
And now the patient's only 65, 66 years old.

981
00:46:02,560 --> 00:46:03,560
Got to be dentures, right?

982
00:46:03,560 --> 00:46:04,560
At that point.

983
00:46:04,560 --> 00:46:05,560
Yeah.

984
00:46:05,560 --> 00:46:08,000
And that's still, and that, and what's the, what's the morbidity on that?

985
00:46:08,000 --> 00:46:09,000
Right?

986
00:46:09,000 --> 00:46:10,880
So that's, you know, it's not like that.

987
00:46:10,880 --> 00:46:15,200
So I mean, but you know, zygomas, you could talk zygomas, you could talk like, you know,

988
00:46:15,200 --> 00:46:18,280
there's still other things to do, but it's very invasive.

989
00:46:18,280 --> 00:46:21,720
It's, you know, it's interesting.

990
00:46:21,720 --> 00:46:22,880
That's a very interesting thought.

991
00:46:22,880 --> 00:46:25,560
Cause I'm just learning about, and don't get me wrong.

992
00:46:25,560 --> 00:46:26,560
I'm not bashing.

993
00:46:26,560 --> 00:46:27,560
I've done it.

994
00:46:27,560 --> 00:46:28,560
Like this is what I'm saying.

995
00:46:28,560 --> 00:46:32,400
So this is the things that we talk about, you know, yeah, constantly learning.

996
00:46:32,400 --> 00:46:34,840
I follow, I follow or constantly learning.

997
00:46:34,840 --> 00:46:35,840
We got it.

998
00:46:35,840 --> 00:46:36,840
We got to do this.

999
00:46:36,840 --> 00:46:38,240
Maybe I know Dr. Gish likes to lecture.

1000
00:46:38,240 --> 00:46:43,000
Would you guys maybe come on together and we have a session where we kind of go through

1001
00:46:43,000 --> 00:46:47,240
the stepwise process, cause I know there are multiple processes that need to be made before

1002
00:46:47,240 --> 00:46:50,360
we even get to talking about implants and whatnot.

1003
00:46:50,360 --> 00:46:51,360
The body level.

1004
00:46:51,360 --> 00:46:54,880
So yeah, Dr. Gish, I'm sure would, would love to talk.

1005
00:46:54,880 --> 00:46:55,880
I'll talk to him.

1006
00:46:55,880 --> 00:46:57,360
I mean, Dr. Gish is a great teacher.

1007
00:46:57,360 --> 00:46:58,360
He really is.

1008
00:46:58,360 --> 00:47:00,920
I mean, he's good at, good at explaining.

1009
00:47:00,920 --> 00:47:03,680
He's one of the good, you know, and that's kind of the same way.

1010
00:47:03,680 --> 00:47:07,200
They both know occlusion.

1011
00:47:07,200 --> 00:47:12,400
They both know prosthetics and they have to, they know up to where they need to know.

1012
00:47:12,400 --> 00:47:13,400
Like you know what I'm saying?

1013
00:47:13,400 --> 00:47:14,400
And stuff like that.

1014
00:47:14,400 --> 00:47:17,520
Like where, because they do these cases and you have to know and just think about it.

1015
00:47:17,520 --> 00:47:22,200
When you do ortho-anathetic surgery, you have to know occlusion.

1016
00:47:22,200 --> 00:47:25,280
You have to know, like you have to know this stuff, right?

1017
00:47:25,280 --> 00:47:26,280
Right.

1018
00:47:26,280 --> 00:47:27,680
Brian's stuff like that.

1019
00:47:27,680 --> 00:47:32,960
So I mean, it's, it's, but it's a topic we can talk about all, you know, you know, all

1020
00:47:32,960 --> 00:47:33,960
the time.

1021
00:47:33,960 --> 00:47:36,000
I think that, that would be really good.

1022
00:47:36,000 --> 00:47:38,680
Say when patients know about it, it's on TV.

1023
00:47:38,680 --> 00:47:40,200
I mean, you get them all the time.

1024
00:47:40,200 --> 00:47:41,200
I get it all the time.

1025
00:47:41,200 --> 00:47:42,200
Yeah.

1026
00:47:42,200 --> 00:47:47,040
And then with the residents, I see the patients just like, I want to all on the case, you

1027
00:47:47,040 --> 00:47:52,200
know, you know, and, you know, and where it's, where it happens.

1028
00:47:52,200 --> 00:47:53,560
So let's do it.

1029
00:47:53,560 --> 00:47:55,400
Let's make that the next talk.

1030
00:47:55,400 --> 00:47:59,560
That's all I can reach out to Dr. Gashim and, and see if, you know, I'm sure he'd like,

1031
00:47:59,560 --> 00:48:02,760
would, he's very, you know, like, you know, just keep fighting the time to get us both

1032
00:48:02,760 --> 00:48:03,760
together.

1033
00:48:03,760 --> 00:48:04,760
That would be fun.

1034
00:48:04,760 --> 00:48:05,760
You know, I'm sorry.

1035
00:48:05,760 --> 00:48:06,760
It'll be great.

1036
00:48:06,760 --> 00:48:07,760
Let's work around your schedules best weekend.

1037
00:48:07,760 --> 00:48:09,080
So Raj will set up, we'll try and eat for a Wednesday.

1038
00:48:09,080 --> 00:48:11,720
Let's plant it for, let's plant it for April though.

1039
00:48:11,720 --> 00:48:12,720
Let's give it some time.

1040
00:48:12,720 --> 00:48:13,720
Yeah.

1041
00:48:13,720 --> 00:48:14,720
You know, some time.

1042
00:48:14,720 --> 00:48:15,720
Yeah.

1043
00:48:15,720 --> 00:48:16,720
I'm sure.

1044
00:48:16,720 --> 00:48:17,720
Let's do it.

1045
00:48:17,720 --> 00:48:18,720
That'll be great.

1046
00:48:18,720 --> 00:48:19,720
That'll be awesome.

1047
00:48:19,720 --> 00:48:21,720
So as a dental, you know, as a, as a pre dental student, right?

1048
00:48:21,720 --> 00:48:22,720
Yeah.

1049
00:48:22,720 --> 00:48:25,720
So you're obviously working in private practice.

1050
00:48:25,720 --> 00:48:26,720
Like so you're volunteering.

1051
00:48:26,720 --> 00:48:27,720
No.

1052
00:48:27,720 --> 00:48:31,800
So I've been working as his twight for two years almost now.

1053
00:48:31,800 --> 00:48:32,800
You know, pre-deadsel?

1054
00:48:32,800 --> 00:48:33,800
Yeah.

1055
00:48:33,800 --> 00:48:34,800
I work over there.

1056
00:48:34,800 --> 00:48:35,800
Okay.

1057
00:48:35,800 --> 00:48:36,800
Yeah.

1058
00:48:36,800 --> 00:48:37,800
Do you know Dr. Pradensi?

1059
00:48:37,800 --> 00:48:38,800
He's also across Dallas.

1060
00:48:38,800 --> 00:48:39,800
He's also, he went to Sunday.

1061
00:48:39,800 --> 00:48:40,800
I've heard of him.

1062
00:48:40,800 --> 00:48:41,800
Yeah.

1063
00:48:41,800 --> 00:48:42,800
He works there.

1064
00:48:42,800 --> 00:48:44,800
There's Dr. Vibert, Dr. Benoy, Dr. Herron.

1065
00:48:44,800 --> 00:48:46,800
Dr. Benoy, I trained.

1066
00:48:46,800 --> 00:48:47,800
Yeah.

1067
00:48:47,800 --> 00:48:48,800
He probably knows you too.

1068
00:48:48,800 --> 00:48:49,800
Yeah.

1069
00:48:49,800 --> 00:48:50,800
Great guy.

1070
00:48:50,800 --> 00:48:51,800
He's like my main mentor.

1071
00:48:51,800 --> 00:48:53,800
He's the one who got me working there.

1072
00:48:53,800 --> 00:48:56,800
It's been really amazing to see a bunch of different things.

1073
00:48:56,800 --> 00:48:57,800
All in four cases.

1074
00:48:57,800 --> 00:49:02,800
We built a new office just for this, just for all in X cases, I guess you can call him.

1075
00:49:02,800 --> 00:49:04,800
You know, see a lot of root canals and plants, crowns.

1076
00:49:04,800 --> 00:49:06,800
I see everything over there.

1077
00:49:06,800 --> 00:49:07,800
So it's great.

1078
00:49:07,800 --> 00:49:09,800
Because it does help to see it.

1079
00:49:09,800 --> 00:49:10,800
It helps.

1080
00:49:10,800 --> 00:49:18,800
I always tell, you know, pre-Dallas students, just by watching, you learn things and you

1081
00:49:18,800 --> 00:49:22,800
made that, not until you get into clinic, but all of a sudden you're in clinic.

1082
00:49:22,800 --> 00:49:23,800
Like I know how to do this, or pre-clinic.

1083
00:49:23,800 --> 00:49:25,800
I know, I've seen this so many times I could do this.

1084
00:49:25,800 --> 00:49:28,800
Like you don't say, even though it's a lot harder holding the drill, right?

1085
00:49:28,800 --> 00:49:30,800
When you see somebody doing it, it's like, I can do that.

1086
00:49:30,800 --> 00:49:31,800
And then you do it.

1087
00:49:31,800 --> 00:49:32,800
You're like, oh my God.

1088
00:49:32,800 --> 00:49:33,800
It's more than harder than I thought it was.

1089
00:49:33,800 --> 00:49:37,800
Well, something that's probably like a mic or a make a temporary for a patient for a

1090
00:49:37,800 --> 00:49:38,800
prep.

1091
00:49:38,800 --> 00:49:41,440
But even that, it's like, damn, okay, I really get into it.

1092
00:49:41,440 --> 00:49:44,800
I've always wanted to, you know, shadowing is one thing, but I feel like getting into

1093
00:49:44,800 --> 00:49:48,800
the chair and holding a suction, like get past them instruments is like another level.

1094
00:49:48,800 --> 00:49:52,800
And then obviously being a dental student and then, you know, where you guys are at.

1095
00:49:52,800 --> 00:49:54,800
So, well, that's kind of my thought process.

1096
00:49:54,800 --> 00:50:00,080
Well, when I was a dental student, I remember telling my dad that I only wanted to work

1097
00:50:00,080 --> 00:50:02,800
on lower teeth because I couldn't use the mirror.

1098
00:50:02,800 --> 00:50:05,800
That's true.

1099
00:50:05,800 --> 00:50:07,800
That's true.

1100
00:50:07,800 --> 00:50:09,800
And then he said a great thing to me.

1101
00:50:09,800 --> 00:50:11,800
He goes, well, do you comb your hair in the mirror?

1102
00:50:11,800 --> 00:50:12,800
I go, yeah.

1103
00:50:12,800 --> 00:50:13,800
And he goes, do you think about it?

1104
00:50:13,800 --> 00:50:15,800
I go, no, he goes, and that's what will happen.

1105
00:50:15,800 --> 00:50:17,800
You want to do this?

1106
00:50:17,800 --> 00:50:18,800
Exactly.

1107
00:50:18,800 --> 00:50:19,800
That's pretty good.

1108
00:50:19,800 --> 00:50:20,800
Yeah.

1109
00:50:20,800 --> 00:50:22,800
So, I mean, so, yeah.

1110
00:50:22,800 --> 00:50:24,800
So, and everything.

1111
00:50:24,800 --> 00:50:26,800
But I, you know, so private practice.

1112
00:50:26,800 --> 00:50:27,800
Yeah.

1113
00:50:27,800 --> 00:50:30,800
So, I mean, just like, private practice is great.

1114
00:50:30,800 --> 00:50:36,800
And private practice is, you know, I really do, I like, you know, I have enjoyed it.

1115
00:50:36,800 --> 00:50:41,800
You know, I have enjoyed my ride and continue to enjoy it, like, you know, and stuff like

1116
00:50:41,800 --> 00:50:42,800
that.

1117
00:50:42,800 --> 00:50:44,800
It's a great profession.

1118
00:50:44,800 --> 00:50:51,800
So, the profession you guys are going into is an unbelievable profession.

1119
00:50:51,800 --> 00:50:56,800
And when you, the days are, the stressful days come, just remember it's because you are

1120
00:50:56,800 --> 00:50:57,800
in a great profession.

1121
00:50:57,800 --> 00:51:00,800
And if it was easy, everybody would do it.

1122
00:51:00,800 --> 00:51:01,800
That's right.

1123
00:51:01,800 --> 00:51:05,800
Basically, what if I'm sad to, you know, you know, I know I talked to you when you were

1124
00:51:05,800 --> 00:51:10,800
having your tough days and I'm like, just, just take it on the chin and move on.

1125
00:51:10,800 --> 00:51:11,800
That's it.

1126
00:51:11,800 --> 00:51:13,800
That's all you can do.

1127
00:51:13,800 --> 00:51:15,800
My chin's pretty broken right now.

1128
00:51:15,800 --> 00:51:16,800
Yeah.

1129
00:51:16,800 --> 00:51:17,800
So.

1130
00:51:17,800 --> 00:51:19,800
Oh, it's, it's, it's rough.

1131
00:51:19,800 --> 00:51:24,800
I mean, today was another 13 hour day, but you know, oh, it's good stuff.

1132
00:51:24,800 --> 00:51:26,800
But yeah, let's, so that's cool.

1133
00:51:26,800 --> 00:51:28,800
We got, we got another one coming up.

1134
00:51:28,800 --> 00:51:30,800
We'll do that in a month or a month and a half.

1135
00:51:30,800 --> 00:51:34,800
And, and yeah, because I got to start, I got to go eat dinner still.

1136
00:51:34,800 --> 00:51:35,800
But that's it, man.

1137
00:51:35,800 --> 00:51:36,800
Now, congratulations.

1138
00:51:36,800 --> 00:51:37,800
Thanks for having me.

1139
00:51:37,800 --> 00:51:38,800
I appreciate it.

1140
00:51:38,800 --> 00:51:39,800
You're ready after you.

1141
00:51:39,800 --> 00:51:40,800
I'm not on.

1142
00:51:40,800 --> 00:51:41,800
Well, thank you.

1143
00:51:41,800 --> 00:51:42,800
All right.

1144
00:51:42,800 --> 00:51:45,800
So you guys, good luck with everything that you're doing and we'll talk soon.

1145
00:51:45,800 --> 00:51:46,800
Absolutely.

1146
00:51:46,800 --> 00:51:47,800
I'll see you Friday, Dr. Cash.

1147
00:51:47,800 --> 00:51:48,800
I'll see you Friday.

1148
00:51:48,800 --> 00:51:49,800
I'll see you Friday too.

1149
00:51:49,800 --> 00:51:50,800
All right.

1150
00:51:50,800 --> 00:51:51,800
And Siraj, congrats, man.

1151
00:51:51,800 --> 00:51:53,800
Yeah, congrats on the D.A.T.

1152
00:51:53,800 --> 00:51:54,800
That's great.

1153
00:51:54,800 --> 00:51:55,800
Big thing over now.

1154
00:51:55,800 --> 00:51:58,800
Just got to apply and then that's it.

1155
00:51:58,800 --> 00:51:59,800
Yeah.

1156
00:51:59,800 --> 00:52:00,800
You got to have a drink now.

1157
00:52:00,800 --> 00:52:01,800
You weren't a drink.

1158
00:52:01,800 --> 00:52:02,800
I think I saw my mom earlier.

1159
00:52:02,800 --> 00:52:04,800
We did, we did have a little drink with my mom.

1160
00:52:04,800 --> 00:52:05,800
So there we go.

1161
00:52:05,800 --> 00:52:06,800
Oh, that's special.

1162
00:52:06,800 --> 00:52:07,800
It's seven metal.

1163
00:52:07,800 --> 00:52:09,800
It's just, just drink.

1164
00:52:09,800 --> 00:52:10,800
So it's pretty fun.

1165
00:52:10,800 --> 00:52:11,800
That's a big night.

1166
00:52:11,800 --> 00:52:13,800
I tell you, you know, she's proud of me.

1167
00:52:13,800 --> 00:52:15,800
So you know, she's passed out.

1168
00:52:15,800 --> 00:52:18,800
Yeah, it's because she never drank and you gave her a drink and that's.

1169
00:52:18,800 --> 00:52:20,800
That's not, she's next.

1170
00:52:20,800 --> 00:52:23,800
Oh, this one.

1171
00:52:23,800 --> 00:52:28,800
I was shaking like the last 40 an hour.

1172
00:52:28,800 --> 00:52:29,800
Yeah.

1173
00:52:29,800 --> 00:52:31,800
I got a J.U. feel like the D.A.T.s was, I remember it.

1174
00:52:31,800 --> 00:52:36,800
And the only reason why I remember it is it allowed me to be like somber on this, but

1175
00:52:36,800 --> 00:52:38,800
my sister had passed away in a car.

1176
00:52:38,800 --> 00:52:40,800
It's a month before.

1177
00:52:40,800 --> 00:52:44,800
And so I kind of went into the D.A.T.s and I wasn't in a good state of mind.

1178
00:52:44,800 --> 00:52:47,800
Like I was still upset and you know, and everything like that.

1179
00:52:47,800 --> 00:52:50,800
And I think it made me do better because I was just very relaxed.

1180
00:52:50,800 --> 00:52:52,800
Like I wasn't, I didn't care.

1181
00:52:52,800 --> 00:52:55,800
I was just like, in my own like, like my thing.

1182
00:52:55,800 --> 00:53:00,800
And I can remember like, I remember, I don't remember the test.

1183
00:53:00,800 --> 00:53:01,800
I remember taking it.

1184
00:53:01,800 --> 00:53:06,800
I just don't remember like, you know, because I was interested in a different place at that point.

1185
00:53:06,800 --> 00:53:11,800
But it's, for sure, it's a stressful day.

1186
00:53:11,800 --> 00:53:17,800
I think the clinical board exam is probably the most stressful day that we have.

1187
00:53:17,800 --> 00:53:19,800
You have the dentistry.

1188
00:53:19,800 --> 00:53:20,800
I would think.

1189
00:53:20,800 --> 00:53:24,800
Where you do the clinicals like, you know, for your licensing.

1190
00:53:24,800 --> 00:53:27,800
So it was the Northeast Regional Board when we took it.

1191
00:53:27,800 --> 00:53:29,800
You know, that's what it was.

1192
00:53:29,800 --> 00:53:32,800
You know, it seemed the D.A.T. is not the most stressful day of your dental career.

1193
00:53:32,800 --> 00:53:34,800
But you know, it's what it's like first.

1194
00:53:34,800 --> 00:53:36,800
One of the factors.

1195
00:53:36,800 --> 00:53:38,800
But like, because you put so much weight on it, right?

1196
00:53:38,800 --> 00:53:41,800
You know, I mean, you're pretty good at doing stuff like that.

1197
00:53:41,800 --> 00:53:47,800
You'll look back on it and be like, I can't believe I was in worried or like, you know, and so it's like like college, right?

1198
00:53:47,800 --> 00:53:51,800
So it's like college, you, when you're in college, you've got a dentistry.

1199
00:53:51,800 --> 00:53:54,800
You was like, oh my God, whatever.

1200
00:53:54,800 --> 00:53:56,800
You get through it.

1201
00:53:56,800 --> 00:53:57,800
You get through it.

1202
00:53:57,800 --> 00:54:00,800
There's always another stressful exam, another stressful day.

1203
00:54:00,800 --> 00:54:29,800
It's learning how to manage it.