Realism, Mistakes and Radical Honesty in Dentistry – IC074

Why does dentistry on social media look so perfect? Are those flawless before-and-after cases the reality of everyday practice—or just the highlight reel? And why aren’t we talking more openly about the failures, frustrations, and imperfect outcomes that every dentist experiences? In this episode, Dr Artem Mkrtichyan joins Jaz for a refreshingly honest conversation about the realities of modern dentistry. Known for his candid and relatable social media posts, Dr. Artem has built a following by sharing what many dentists think—but rarely say out loud: dentistry is hard, results aren’t always perfect, and social media often paints an unrealistic picture of the profession. https://youtu.be/uTKaeewgrgE Watch IC074 on YouTube Key Takeaways Social media has become a powerful tool for dentists to connect and share experiences. Mistakes in clinical practice are common and should be openly discussed. Rural practice may not always lead to higher income as expected. Success in dentistry is subjective and varies for each individual. Continuous learning and skill development are crucial for career growth. Financial freedom in dentistry is not guaranteed and varies widely. Networking and mentorship can significantly impact career progression. Social media can be leveraged to attract patients and build a personal brand. Highlights of this episode: 00:00 Teaser 00:18 Introduction 02:24 Meet Dr Artem Mkrtichyan 05:27 Rejections And Resilience 09:03 Why Honesty Wins 10:58 Rural Dentistry Reality 14:58 Handling Online Criticism 16:01 Associate Vs Owner Myth 18:05 Midroll: Protrusive App 22:48 Dentistry Money Reality 26:57 Design Your Career Path 28:00 Standing Out In Saturated Markets 29:27 Content Marketing Strategy 31:46 Veneer Minimum Ethics 33:48 Final Advice And Community If this episode resonated with you, don’t miss “I Committed Fraud – Learn from My Mistakes” – PDP248 #InterferenceCast #BeyondDentistry This episode is not eligible for CPD/CE points, but never fear, there are hundreds of hours of CPD waiting for you on the Ultimate Education Plan.

Why does occlusion feel so confusing at dental school? What if the problem is not that occlusion is too complex, but that it was taught in the wrong order? How do you make sense of worn teeth, bite scans, shimstock, leaf gauges, provisionals and T-Scan without getting overwhelmed? And which small ideas can genuinely change the way you diagnose, plan and restore? In this episode, Jaz is joined by Dr. Mahmoud Ibrahim for a brilliant occlusion-focused conversation. They each bring five clinical “pearls” that helped occlusion finally click for them — from facially generated treatment planning to checking the contralateral side, muscle palpation, provisionals and digital occlusal data. https://youtu.be/REQ_L5NNEF4 Watch PDP267 on YouTube Protrusive Dental Pearl Create a PowerPoint or Keynote library of your clinical photos so you can quickly show patients relevant examples during consultations. ⚠️ Avoid hunting through random folders chairside — it feels clunky and breaks the flow of the conversation. ✅ Build a scrollable visual library of cracks, before-and-afters, complications, direct restorations, overlays, crowns and consent examples to support clearer patient communication. Key Takeaways Occlusion becomes easier when it is placed inside the treatment planning sequence, not treated as a separate subject. Facially generated treatment planning starts with where the upper teeth need to be for aesthetics. Once the central incisors are planned, the rest of the occlusion becomes easier to organise. Worn teeth that are still in occlusion are often in the wrong position. Anterior wear may be caused by tooth position, contact time, contact force, or a combination of all three. Gingival levels can reveal whether worn lower incisors have over-erupted. Digital bite scans are useful, but they are not always a perfect representation of the patient’s bite. Shimstock remains one of the most valuable and inexpensive tools for checking true occlusal contacts. After fitting a restoration, checking the contralateral side first can reveal whether the new restoration is high. Anterior guidance should be steep enough to separate the back teeth, but shallow enough to allow the lower incisors room to move. Muscle palpation should assess the quality and symmetry of contraction, not just whether the muscles exist. Always assess the opposing tooth before placing composite, ceramic or an indirect restoration. A leaf gauge can help create a more repeatable jaw position when planning more complex occlusal cases. Provisionals are essential for testing aesthetics, function, vertical dimension and occlusion before committing to final restorations. Highlights of the Episode: 00:00 Teaser 00:56 Introduction 03:36 Pearl: Build a Clinical Photo PowerPoint 12:48 Pearl 1: Facially Generated Treatment Planning 15:56 Pearl 2: Worn Teeth in Occlusion Are in the Wrong Position 18:05 Why Tooth Position Matters 18:22 Three Causes of Wear to Consider 19:34 Pearl 3: Digital Bite Scans Are Not Always Accurate 20:24 Why Shimstock Still Matters in Digital Dentistry 24:18 Pearl 4: Check the Contralateral Side After a Restoration 26:27 Pearl 5: The First Movement of Opening Is Not Pure Rotation 28:27 Midroll 33:10 Pearl 6: Healthy Occlusion Should Have Coordinated Muscle Contraction 35:22 Why Muscle Palpation Is a Useful Data Point 38:18 Practical Muscle Assessment Tip 38:58 Pearl 7: Always Look at the Opposing Tooth 39:33 What to Check Before an Indirect Restoration 39:44 Why the Opposing Tooth Matters 41:13 Pearl 8: Leaf Gauge for Finding a Repeatable Jaw Position 42:43 What a Leaf Gauge Is 44:33 Pearl 9: Provisionals Reduce the Fear of Complex Cases 47:49 Pearl 10: T-Scan Adds Objective Occlusal Data 53:16 Course Options and Learning Pathway 55:59 Outro ✨Connect with Dr. Mahmoud on Instagram 📍 Want to make occlusion more practical? Bulletproof is designed to take occlusion from abstract theory to real-world clinical application — covering posterior crowns, quadrant dentistry, PROPER conformative dentistry, occlusal risk assessment, shimstock, leaf gauges and daily protocols you can use straight away. The next Bulletproof course takes place on 26th–27th June at London Heathrow (Radisson Blu Hotel) Don’t miss it — find out more at bulletproofdentistry.com ➡️Check out more episodes on occlusion: Indirect Restorations For Guiding Teeth – PDP196 #PDPMainEpisodes  #OcclusionTMDandSplints This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes C AGD Subject Code: 180 Occlusion Aim: To help dentists improve their understanding and clinical application of occlusion by recognising key diagnostic signs, using practical occlusal assessment tools, and applying occlusal principles to restorative treatment planning. Dentists will be able to – Apply facially generated treatment planning principles when assessing occlusal and restorative cases. Identify how tooth position, contact time and contact force contribute to tooth wear and restoration risk. Use practical occlusal assessment methods such as shimstock, contralateral checking, muscle palpation, leaf gauges, provisionals and T-Scan data.

Are we overcomplicating posterior composites? Are those beautiful fissures and stains actually helping the patient… or just us? Why does that “perfect” restoration suddenly need 20 minutes of occlusal adjustment after rubber dam removal? And how can we make functional, predictable composites without burning time or stress? In this episode, Dr. Vishaal Shah shares a refreshingly practical approach to posterior composites. From understanding the basics, to simplifying anatomy and improving efficiency, this is a grounded, clinically focused conversation on how to deliver restorations that actually serve the patient. https://youtu.be/tdkTxzcloN0 Watch PDP266 on YouTube Protrusive Dental PearlMatch your composite anatomy to the patient’s dental age and opposing dentition before you start building. ⚠️ Overbuilding cusps in a worn dentition will create occlusal interferences and wasted adjustment time✅ Assess space, wear, and occlusion first—then design the restoration accordingly Key Takeaways Function, efficiency, and occlusal compatibility should guide every restoration Dental age (wear) is more important than chronological age when planning anatomy Always assess the opposing tooth before designing cusps and fissures Use the whole arch—not just the contralateral tooth—as your anatomical guide Follow the central fissure line across the quadrant to orient your restoration Avoid textbook anatomy in worn dentitions—adapt to what’s present Large MOD composites often act as interim restorations before crowns Build proximal walls first to establish contact and control final contour Use composite slump (with a microbrush) to naturally form proximal curvature Base layer height should match the deepest fissure level of adjacent teeth Map out fissures and cusps before building to improve accuracy and speed Start with the most difficult cusp first to reduce fatigue-related errors Proper planning before drilling reduces occlusal errors and remakes Highlights of the Episode: 00:00 Teaser 01:08 Introduction 01:50 Pearl: Matching Anatomy to Dental Age 05:32 Posterior Composite: Start with Basics, Not Complexity 10:42 Efficient Approach to Large Restorations 14:22 Efficiency vs Ideal Posterior Restorations 19:25 Building Proximal Walls First 20:55 Using Putty Stents for Missing Cusps 23:54 Midroll 27:15 Using Putty Stents for Missing Cusps 27:25 Matrix System Selection 28:06 No Pre-Wedging Philosophy 29:06 Managing Composite Overhangs 30:46 Matrix Ring Differences 32:45 Interjection 37:03 Matrix Ring Differences 37:43 Proximal Wall Technique for Posterior Composite 41:03 Base Layer Strategy in Posterior Restorations 42:23 Mapping Anatomy Before Composite Build-Up 43:13 Cusp Build-Up Approach 45:03 Minimal Adjustment Philosophy 46:43 Final Philosophy: Keep It Simple 48:00 Learning Opportunities 49:54 Outro 🔥 Want to level up your posterior composites?Dr. Vishaal Shah runs hands-on courses focused on simplifying and mastering everyday restorations.👉 Visit www.levelupdentistry.com to explore courses and upcoming training opportunities. More about posterior restorations:Check out more episodes on occlusion and restorative dentistry: How to Place Posterior Composites without Destroying Your Anatomy – PDP200 #PDPMainEpisodes  #BreadandButterDentistry  This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes C AGD Subject Code: 250 Operative Dentistry Aim: To enhance clinicians’ understanding of efficient, functional posterior composite techniques with a focus on anatomy, occlusion, and practical workflow. Dentists will be able to – Assess dental age and occlusal compatibility when planning posterior composites Apply simplified, efficient techniques to build functional posterior restorations Select appropriate materials and matrix systems to optimise contact, contour, and outcomes

When is it appropriate to consider an MRI for your TMD patient? What’s actually involved in MRI of the TMJ? Can you use any MRI machine, or is the choice of imaging center crucial? And who should be reporting on these scans — does it really matter? (Hint: yes, it does!) Dr. Kevin Lotzof, a straight-talking radiologist, joins Jaz for a controversial deep dive into the role of MRI in Temporomandibular Disorders. While many experts downplay its importance, Kevin argues that TMJs are under-imaged and under-diagnosed — and that we may be missing critical pathology. They explore the practicalities of imaging, how to set expectations with your patients, and why strong but differing views in TMD care can ultimately help you refine your own clinical approach. https://youtu.be/-yo_Qx4Zg5Q Watch PDP265 on YouTube  Protrusive Dental Pearl: Adopt the mindset of “Find the cancer today.”When carrying out examinations—whether soft tissue or extraoral—approach it with the intention of detecting oral or skin cancers early. This mindset helps clinicians look beyond just teeth, catch unusual or suspicious lesions, and potentially save lives. Key Takeaways TMJ is often overlooked but is crucial for overall health. MRI is essential for accurate TMJ diagnosis. Cone beam CT cannot replace MRI for TMD assessment. Patients with headaches may have undiagnosed TMD. Education on TMJ imaging is lacking among dental professionals. Asymptomatic patients should still be scanned for TMJ issues. The quality of imaging directly impacts diagnosis accuracy. Patients often feel anxious about MRI procedures. Understanding patient perspectives can improve care. There is a need for better collaboration between dentists and radiologists. Highlight of the episode: 00:00 Teaser 00:55 Intro 05:20 Protrusive dental pearl 06:36 Interview with Dr. Kevin Lotzof 09:38 Under-Imaging and Differing Perspectives 13:27 Access and MRI Centers in the UK 17:51 TMJ MRI: Patient Expectations 22:17 Midroll 25:53 Open MRI Machines 27:26 Ideal Candidates for MRI Imaging 29:55 Cone Beam CT vs. MRI 31:53 Screening and Asymptomatic Patients 38:43 Centers with Reliable TMJ Imaging 41:27 Encouragement for General Dentists 46:33 Outro Where to Get Reliable TMJ Imaging ⭐ Top Pick: Orion, Wimpole Street, London(Full contact details available via the Protrusive Guidance App) 🏙️ Other London Options: Spire Bushey, Circle Hendon, Cavell, Kings Oak, Circle Healthcare Center  Learn more about TMJ radiographic imaging in PDP223: Understanding TMD Radiographic Imaging – Pano vs CBCT vs MRI #PDPMainEpisodes #OcclusionTMDandSplints #CareerDevelopment This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance.  This episode meets GDC Outcomes A and C. AGD Subject Code: 730 ORAL MEDICINE, ORAL DIAGNOSIS, ORAL PATHOLOGY (Imaging techniques) Aim: To highlight the importance of MRI in the diagnosis and management of temporomandibular joint (TMJ) disorders, ensuring safe and effective orthodontic and restorative treatment planning. Dentists will be able to: Explain why MRI is superior to clinical examination and CBCT in diagnosing TMJ pathology. Identify the key indications for TMJ MRI, including both dental and non-dental symptoms. Recognize the limitations of poor imaging technique and reporting in TMJ diagnosis

Is titanium still the gold standard for implants? Are zirconia implants just hype from biological dentistry… or something more? Do ceramic implants really integrate as well as titanium? And should we already be offering patients a choice? Zirconia implants are no longer a fringe concept—they’re entering mainstream conversations. In this episode, Dr. Pav Khaira returns to break down the science, clinical decision-making, and real-world application of zirconia vs titanium implants. From corrosion and osteoimmunology to occlusion and case selection, this is a practical, evidence-led discussion for clinicians navigating modern implant options. https://youtu.be/-RCvf2KOdSc Watch PDP264 on YouTube Protrusive Dental Pearl: Thriving in Challenging Times 💡 Prioritize quality sleep—it sharpens decision-making, improves mood, and reduces irritability (6–7 solid hours beats longer, disrupted sleep). ➡️ Remember, stress comes from how we respond, not the situation itself—focus on what you can control and let go of the rest. 📢 Lean on your support system and make time for reflection and gratitude—they help reframe pressure and build resilience. Key Takeaways Zirconia implants integrate just as well as titanium, with comparable clinical outcomes Early healing may be slightly faster around zirconia, but long-term results are similar Titanium can corrode over time, releasing particles linked to peri-implantitis Zirconia does not corrode, removing this biological risk factor Modern implant thinking focuses on osteoimmunology, not just osseointegration Zirconia implants are often one-piece → no microgap and improved crestal bone stability Surgical placement must be highly precise—zirconia is less forgiving than titanium Guided osteotomy is strongly recommended for ceramic implants Fracture risk in modern zirconia implants is low when manufactured correctly Hot isostatic pressing significantly increases zirconia strength and reduces defects Case selection is critical—limited bone or complex angulation may favour titanium Zirconia implants are typically cement-retained only Excess cement remains a risk factor for peri-implant disease → manage carefully Zinc phosphate cement is useful due to radiopacity and bacteriostatic properties Angled screw correction (titanium) is predictable only up to ~15 degrees Patient preference for metal-free dentistry is a growing driver of zirconia demand Episode Highlights 00:00 Teaser 00:49 Introduction 02:32 Protrusive Dental Pearl: Advice for Dentists during challenging times 05:14 Basics: What Are Implants Made Of? 07:13 Osseointegration: Zirconia vs Titanium 08:28 Why Zirconia? Biological Rationale 11:13 Clinical Advantages of Zirconia Implant 14:09 Zirconia Implants Limitations in Clinical Use 17:45  Case Selection: When to Use Zirconia Implant 19:16 Fracture Risk: Myth vs Reality 21:30 Midroll 24:51 Fracture Risk: Myth vs Reality 25:29 Importance of Manufacturing Zirconia Implants 27:49 Weaknesses & Clinical Considerations of Zirconia Implants 30:49 Occlusal Programming for Implants 32:24 Screw vs Cement Retention in Implants 34:07 Angle Screw Correction (titanium Context) 36:20 Cement Choices for Zirconia Implants 38:27 Market Share & Future Trends of Zirconia Implants 40:25 Learning Resources for Zirconia Implants 41:51 Medico-Legal Considerations of Zirconia Implants 47:37 Training & Education Pathways for Zirconia Implants  48:25 Outro Want to go deeper into implants? Explore Dr. Pav Khaira’s Academy of Implant Excellence— training designed to help you truly understand the why behind implant dentistry, not just follow protocols. Hands-on options, mentorship, and advanced training available. ✨Follow Academy of Implant Excellence on Instagram: https://www.instagram.com/academyofimplantexcellence Mentioned resources from this Episode Book: Zirconia: Material Properties and Surgical Principles for Dental Implants and Restorations Want more? 📢 Check out more episodes on implant complications and treatment planning Implant Occlusion that Makes Sense – PDP 204 Implant Assessment for GDPs: from Space Requirement to Ridge Preservation – PDP052 #PDPMainEpisodes This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes C AGD Subject Code: 690 Implants Aim: To improve understanding of zirconia implants, including biological considerations, clinical indications, limitations, occlusal principles, consent, and material-related decision-making. Dentists will be able to – Describe the clinical and biological considerations when comparing zirconia and titanium implants Identify key case selection factors and limitations for zirconia implant treatment Apply practical principles for occlusion, cementation, consent, and risk reduction in implant dentistry

Is burnout inevitable in dentistry? Why do so many high-achieving dentists still feel unfulfilled? Are we too harsh on ourselves without even realising it? And what if the way we speak to ourselves is the real problem? In this episode, Jaz sits down with Dr Aditi Bhalla—a Prosthodontist and Integrative Psychotherapist, with over 15 years in dentistry and extensive training in mental health, mindfulness, and movement—to explore compassion-focused dentistry. They unpack burnout, perfectionism, fear-driven practice, and how understanding your mind could be the key to a sustainable, fulfilling career. https://youtu.be/pNsW6AiWsWQ Watch IC073 on Youtube Key Takeaways Burnout often stems from perfectionism, shame, and constant self-criticism Many dentists tie their self-worth entirely to clinical performance Childhood experiences can shape how we respond to stress and pressure High-functioning anxiety is common but often goes unnoticed NHS-style time pressure and fear of complaints drive chronic stress Decision fatigue in dentistry significantly impacts performance and wellbeing Social media amplifies comparison and feelings of inadequacy There is a growing gap between expectations and real-world dentistry Compassion requires courage, wisdom, and commitment—not weakness Dentists are good at caring for patients but neglect self-care Accepting positive feedback is as important as improving weaknesses Emotional awareness is the first step to managing stress effectively A “compassion toolkit” helps regulate emotions in real-time clinical scenarios Sustainable dentistry requires prevention of burnout, not just coping strategies Team culture improves when you recognise the human behind the role Compassionate leadership still requires clear boundaries and accountability Highlights of this episode: 00:00 Teaser 00:51 Introduction 07:50 What “Therapy” Means 11:43 Role of Childhood & Trauma 13:10 Therapists Need Therapy Too 14:40 Breakdown & Burnout in Dentistry 16:50 Causes of Burnout in Dentistry 19:50 Clinical Stress Factors 20:50 Decision Fatigue in Dentistry 23:35 Burnout in Modern Dentistry – Why More Now? 27:38 Midroll 30:59 Burnout in Modern Dentistry – Why More Now? 31:11 What is Compassion? 32:11 Lack of Self-Compassion in Dentistry 33:11 Three Directions of Compassion in Dentistry 35:11 Compassion Focused Dentistry (CFD) 39:11 Nervous System Awareness 41:31 Applying Compassion in DailyDental Practice 43:01 Compassion = Emotional Intelligence + Mindfulness 43:41 Compassion “Kit Bag” 45:11 Compassion in the Team 46:41 Creating a Compassionate Practice 51:51 Getting Started with Compassion 54:12 Outro 💡 Want to improve your wellbeing and prevent burnout?Dr Aditi Bhalla runs free workshops and resources via the Dental Wellbeing Hub. You can also explore her work and sign up through her website: draditibhalla.com LinkedIn: https://www.linkedin.com/in/draditibhalla/ Facebook: https://www.facebook.com/draditibhalla Dental Wellbeing Hub Instagram: https://www.instagram.com/dentalwellbeinghub #InterferenceCast #BeyondDentistry Want more?Check out the episode with Marco Maiolino on perfectionism in dentistry – Stop Being a Perfectionist – it’s OK to Fail – PDP184 This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes B and D AGD Subject Code: 770 Self-improvement Aim: To explore the principles of compassion-focused dentistry and how emotional awareness, self-compassion, and team dynamics can improve clinician wellbeing and reduce burnout. Dentists will be able to – Recognise the role of emotional awareness and self-compassion in managing clinical stress Identify key contributors to burnout in modern dental practice Apply practical strategies to foster a compassionate and sustainable workplace

Are you sacrificing your health for your patients? Are your neck and back quietly dictating how long you can practise? Do you skip workouts because you “don’t have time”? And what if your career ended—not by choice, but because your body gave up first? In this episode, Jaz is joined by Fraser Smith, a sports scientist and nutrition expert, to break down what dentists actually need to do to stay healthy, pain-free, and practising for longer. From EMS training and realistic exercise routines to nutrition and injury prevention, this is a practical guide to protecting your most important asset—your health. https://youtu.be/kQu7rDlzT8k Watch IC072 on Youtube Key Takeaways Health is a key pillar of career longevity in dentistry Many dentists sacrifice exercise and sleep during high-stress periods Short, consistent workouts are more sustainable than long, infrequent sessions EMS can be a useful time-efficient adjunct but should not replace a full training programme Strength, endurance, and mobility are all essential components of fitness Most dentists should start with small, manageable exercise habits and build gradually Deadlifts are beneficial but require proper technique and guidance Reformer Pilates is a practical option for improving posture and mobility Stretching provides short-term relief but must be combined with strengthening Most musculoskeletal pain in dentists is due to repetitive strain and weakness Movement and gradual strengthening are key to managing and preventing pain Ignoring early pain increases the risk of chronic, persistent symptoms Nutrition should be balanced and sustainable rather than extreme Protein intake is often insufficient in active individuals Supplements can support performance but should not replace a good diet Long-term success depends on prioritising health as part of professional responsibility Highlights of this episode: 00:00 Teaser 00:53 Introduction 05:40 What is EMS Training? 07:45 Get to know Fraser Smith 09:35 What’s the ideal health routine for Dentists? 11:56 Deadlifts for Dentists 15:01 Stretching & Posture Tips for Dentists 18:35 Midroll 21:56 Stretching & Posture Tips for Dentists 25:41 Balanced Nutrition 28:23 Protein Intake Suggestions 30:51 Back Pain Management 39:09 Outro 💡For tailored support with strength, posture, and long-term health,  check out Vive Fitness  Want more? Check out episodes on health and longevity in dentistry: My Neck, My Back (Fix Your Posture While Removing Plaque!) – PDP220 #InterferenceCast #BeyondDentistry This episode is not eligible for CPD/CE points, but never fear, there are hundreds of hours of CPD waiting for you on the Ultimate Education Plan, including Premium clinical walkthroughs and Masterclasses.

(This episode discusses suicide prevention and mental health. It does not include graphic details, but please listen with care. If this topic feels close to home, consider pausing and reaching out to someone you trust or a mental health professional.) Why does dentistry have such high levels of stress and burnout? Why do so many clinicians feel isolated despite working in busy practices? What are the early warning signs that a colleague might be struggling? And what can you actually do — practically — if someone is in crisis? In this powerful and deeply important episode, Professor John Gibson shares his personal story and the mission behind the Canmore Trust. The conversation explores suicide prevention in dentistry, how to recognise warning signs, and the simple but life-saving actions every clinician should know. https://youtu.be/F8uWxhn3B8k Watch IC071 on YouTube Key Takeaways Dentistry has a well-recognised issue with stress, burnout, and suicide risk Suicide is always multifactorial — never caused by a single event Toxic culture, including harassment and unrealistic expectations, contributes to distress Social media comparison can amplify feelings of inadequacy and isolation Dentistry is uniquely demanding — both intellectually and technically Mental health stigma prevents open conversations within the profession Neurodivergence is increasingly relevant and often underdiagnosed Perfectionism is a key risk trait linked to suicidal thinking Working below your moral standards creates significant psychological stress Warning signs include changes in temperament, withdrawal, and isolation Asking directly about suicide does not increase risk — it can save lives Use the “double bounce” approach: ask the question twice if needed If someone says yes, act immediately — hospital or emergency services You are not responsible for managing the crisis alone Early support includes sharing concerns and involving a trusted person GP support can be transformative and should not be delayed Highlight of this episode: 00:00 Teaser 00:51 Intro 04:16 John Gibson Introduction 07:15 Understanding the Scale of Suicide in Dentistry 09:59 Why Suicide Happens in Dentistry 11:13 Key Risk Factors of Suicide in Dentistry 12:09 Social Media and Comparison 12:52 Isolation 13:04 Difficulty of Dentistry 14:03 Mental Health Stigma 15:22 Neurodiversity 18:18 Perfectionism and Moral Conflict in Dentistry 21:44 Recognising Warning Signs of Suicide 21:46 Midroll 25:07 Recognising Warning Signs of Suicide 26:21 How to Approach a Suicidal Colleague 28:49 Double Bounce Technique 30:44 If the Answer is YES 33:36 Support and Resources for Dentists 34:12 Key Suicide Prevention Steps 37:40 Creating a Supportive Workplace 39:18 Reflective Space 40:00 Daily Positivity Practice 42:46 Canmore Trust Podcast 42:59 Outro Learn more about mental health in Dentistry: Check out more episodes on mental health, burnout, and wellbeing in dentistry. PDP185 – Mental Health in Dentistry IC040 – Overcoming Adversities 💙 Support and resourcesIf this episode resonated with you or someone you know, explore the Canmore Trust for practical support and guidance:👉 thecanmoretrust.co.uk 👉 The Canmore Trust Podcast They also offer helpful resources and podcasts focused on suicide prevention and mental well-being for healthcare professionals. ➡️General Dental Council – Mental Health and Well Being in Dentistry: A Rapid Evidence Assessment #InterferenceCast #Communication #BeyondDentistry This episode is eligible for 0.5 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes B AGD Subject Code: 770 Self Improvement (Mental Health / Stress Management) Aim: To enhance clinicians’ understanding of suicide risk within dentistry, including contributing factors, warning signs, and practical approaches to supporting colleagues, fostering open conversations, and creating a mentally healthy workplace. Dentists will be able to – Recognise the multifactorial nature of suicide in dentistry and identify key contributing risk factors such as toxic culture, isolation, and stigma. Identify behavioural and emotional warning signs of suicide in dental professionals and apply appropriate communication strategies, including direct questioning and empathetic support. Implement practical steps to support colleagues in crisis and contribute to a workplace culture that prioritises mental health and wellbeing.

You’ve spotted the signs—wear, scalloping, fragmentation, maybe even a low AHI—but what does that really mean? When the data doesn’t match the symptoms, how do you move forward? And how do you integrate airway into full mouth rehab without compromising function, stability, or predictability? In this episode, Jaz is joined by Dr. Aston Parmar to explore the real-world application of airway dentistry. They discuss how to help patients own their problem, why sleep testing matters, and how airway influences diagnosis, treatment planning, and long-term outcomes. https://youtu.be/-zVV1FAT0NI Watch PDP263 on YouTube Protrusive Dental Pearl Nasal Breathing and Simple Screening Nasal airflow can be a major limiting factor in sleep quality. Simple test: flare nostrils → if breathing improves, nasal resistance may be present. Nasal dilators can be a cheap, low-risk intervention for selected patients. Not all patients need mandibular advancement — sometimes the issue is nasal. Second pearl: test snoring improvement by advancing the mandible. If forward positioning reduces snoring sound → mandibular advancement may help. Key Takeaways Patients must own their problem before accepting treatment Airway dentistry is about risk reduction, not cure Apnea-Hypopnea Index (AHI) has limitations—context and patterns matter more than raw scores Upper Airway Resistance Syndrome (UARS) is common but underdiagnosed Sleep fragmentation can exist even with low AHI scores Myofunctional therapy improves compliance and outcomes Multi-night sleep testing provides more accurate insights Collaboration with ENT specialists improves diagnostic accuracy Airway is the bookend of full mouth rehab (start and end) Dentistry should be airway-sympathetic, not just tooth-focused Mandibular advancement devices are effective but require careful titration Morning occlusal guides help reduce bite changes from appliances Not all patients need the same pathway—risk stratification is key Predictability in dentistry depends on understanding the whole system The environment (airway, function, biology) matters more than the teeth Highlights of this episode: 00:00 – Introduction to Upper Airway Resistance Syndrome 02:08 – Pearl: Nasal Breathing and Simple Screening 07:43 – Recap: Myofunctional Therapy and Indications 08:30 – Role of Myofunctional Therapy in Treatment Planning 09:40 – Patient Communication and Case Acceptance 23:20 – Sleep-Disordered Breathing Spectrum 23:50 – Apnea vs Hypopnea and Apnea-Hypopnea Index (AHI) Limitations 30:00 – Upper Airway Resistance Syndrome (UARS) 35:43 – Management of UARS 37:00 – Mandibular Advancement Devices (MAD) 39:00 – Maxillary Expansion and Surgical Options 41:00 – Treatment Pathway and ENT Involvement 44:00 – Risk Assessment in Full Mouth Rehab 59:30 – Airway-Sympathetic Dentistry 01:02:00 – Treatment Philosophy and Case Selection 01:07:00 – Airway as Bookends of Treatment 01:09:00 – Managing Side Effects of MAD 01:12:00 – Career Insight and Final Reflections Want to learn more? Watch part 1 of this episode: PDP262 – Implementing Sleep, Airway and Myo to Restorative Dentistry Part 1 Also, check out Stop Blaming Bruxism with Dr. Sandra Hulac – PDP142 🦷Master Airway Dentistry in PracticeJoin Dr. Aston Parmar’s course on 8th May in Cardiff Learn how to screen, test, and manage airway patients Understand real-world workflows and patient communication Build confidence in integrating airway into your practice 👉 Book via: www.dentalsleep.co.uk 🦷 Ergonomics Day – Dentistry Without Back Pain! Join us Saturday, 13th June, Heathrow with Dr. Anikó Ball, world-leading ergonomics expert! Learn proper posture, positioning, and techniques to prevent back problems while practicing dentistry. 💺 Hands-on workshop with a mobile dental chair📸 Live camera demo on a big screen💻 Can’t attend in person? Join online with live stream & replay 🎟 Early bird tickets even include a full event video! 👉 Grab your spot now! #PDPMainEpisodes #CareerDevelopment #OrthoRestorative This episode is eligible for 1.25 CE credit via the quiz on Protrusive Guidance.  This episode meets GDC Outcome C AGD Subject Code: 730 – Oral Medicine, Oral Diagnosis, Oral Pathology Aim To provide dentists with a practical understanding of airway-focused dentistry, including sleep assessment, risk-based treatment planning, and the integration of airway considerations into full mouth rehabilitation. Dentists will be able to: Recognize the limitations of AHI and the importance of sleep fragmentation in diagnosis. Understand the role of myofunctional therapy in improving airway function and treatment outcomes. Apply a risk-based approach when integrating airway considerations into restorative and occlusal treatment planning.

What do you actually do once you’ve screened a patient for airway or sleep-disordered breathing? You suspect sleep apnea—but since we can’t diagnose it as dentists, how does that influence the care you provide? What do you do with that information, and who should you be working with to help your patient? And what if you want to implement airway into your practice—but you’re not in the right environment to do so? In this episode, Dr. Aston Parmar joins Jaz to break down how to implement airway in everyday dentistry. Together, they explore what happens after screening, how it influences treatment planning, and how dentists can work with other professionals to deliver better care. https://youtu.be/wGbgbW8muUI Watch PDP262 on YouTube  Protrusive Dental Pearl Use the Mallampati Score as a quick chairside airway screen: have the patient open wide and stick out their tongue. Grade 1 = low risk; higher grades indicate greater Sleep-Disordered Breathing risk.  ⚠️ In TMD patients, limited opening can give falsely high scores.  ✅ Always interpret alongside history and full exam. Key Takeaways Airway management is often overlooked in dental education. Sleep testing can significantly improve patient outcomes. Dentists should focus on airway health to enhance sleep quality. Collaboration with orthodontists can benefit patient care. Myofunctional therapy is crucial for both children and adults. Early intervention before age six is vital for nasal breathing. Tongue function plays a significant role in dental health. Breathing patterns can affect orthodontic stability. The Malampati score is a key indicator of sleep disorder risk. Upper airway resistance syndrome can be difficult to diagnose. Collaboration with myofunctional therapists enhances patient outcomes. Understanding airway health is essential for total body health. Inspiring the next generation of dental professionals is important. Highlights of this episode: 00:00 Teaser 00:51 Introduction 04:03 Protrusive Dental Pearl: Mallampati Score 05:37 Meet Dr. Aston Parmar 09:51 Journey into Dentistry 17:10 Implementing Training in Practice 22:41 First Exposure to Airway Concept 30:18 South Wales Dental Sleep Clinic Model 30:21 Midroll 33:42 South Wales Dental Sleep Clinic Model 41:17 Myofunctional Therapy Explained 48: 51 Orthodontic Stability and Neutral Zone 54:52 Quickfire Screening Red Flags 01:02:55 Sleep Apnea Basics 01:04:23  Upper Area Resistance Syndrome (UARS) 01:08:53 Outro Want more? Check out Airway Dentistry with Jeff Rouse – PDP229 🦷 Ergonomics Day – Dentistry Without Back Pain! Join us Saturday, 13th June, Heathrow with Dr. Anikó Ball, world-leading ergonomics expert! Learn proper posture, positioning, and techniques to prevent back problems while practicing dentistry. 💺 Hands-on workshop with a mobile dental chair📸 Live camera demo on a big screen💻 Can’t attend in person? Join online with live stream & replay 🎟 Early bird tickets even include a full event video! 👉 Grab your spot now! #PDPMainEpisodes #CareerDevelopment #OrthoRestorative This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance.  This episode meets GDC Outcome C AGD Subject Code: 730 – Oral Medicine, Oral Diagnosis, Oral Pathology Aim: To provide a practical, data-driven framework for identifying airway-related risks, understanding myofunctional therapy, and integrating sleep screening into routine dental assessment. Dentists will be able to – Recognize key airway and sleep-related risk factors during routine dental examinations. 2. Understand the role of myofunctional therapy in improving airway function and orthodontic stability. 3. Apply simple chairside screening methods to identify patients who may require further airway assessment.