Protrusive Dental Podcast

Your patient brushes well, avoids sweets — and still keeps getting decay. What if the answer isn’t in their mouth at all? What if two inexpensive finger-prick tests told you more about a patient’s gum disease and implant prognosis than anything on the radiograph? And here’s the uncomfortable one: if the science is this clear, is not checking starting to look like a medico-legal risk? Especially for imlpant surgery! This is a conversation with Dr Tif Qureshi — the dentist who changed how the profession thinks about the lifelong patient, the envelope of function, and Align, Bleach, Bond. He’s gone down a new rabbit hole: metabolic health. In general practice he’s now doing blood tests — HbA1c and vitamin D — and making the case that the mouth isn’t connected to the body, it is the body. This isn’t about becoming a “biological dentist” (as you’ll hear, Tif is refreshingly blunt about the wilder end of that world). It’s about respecting the biology, screening sensibly, and helping patients where we’re genuinely placed to help. https://youtu.be/mt1MXLFCTp0 Watch PDP275 on YouTube Protrusive Dental Pearl: Test Yourself First Before you even think about introducing blood tests for your patients, ask whether you’re checking your own biomarkers at a sensible interval. The deepest way to understand this topic is to learn it on yourself and your family first — run your own HbA1c, vitamin D, iron, and liver and kidney markers, and see what the data tells you. Start quarterly, like hygienist visits, then stretch to six-monthly or annual once things look good. Getting invested in your own numbers is what makes better food and lifestyle choices actually stick — and it’s the honest starting point for ever offering this to a patient. What You’ll Take From This Episode The metabolic lens — why one disordered glucose-and-insulin system sits under so much chronic and dental disease, and why dentistry is well placed to act on it. Sugar, redefined — why patients who avoid sweets still get decay, and how frequency of starchy carbs drives the problem. The two biomarkers that matter most — what HbA1c and vitamin D each tell you about caries, perio and healing. How to run it in practice — finger-prick logistics, what to test, and how to raise it on the medical history form. The medico-legal case — why documenting these markers can protect you before implant, graft and perio work. Highlights of This Episode 00:00  Why Dentists Should Care About Blood Tests 06:00  Metabolic Disease: The Root Cause Dentists Miss 13:00  Why Starchy Carbs Cause Decay, Not Just Sugar 15:50  HbA1c and Caries: What the SHIP Study Shows 21:00  Insulin Resistance: The Hidden Driver of Gum Disease 26:00  How to Talk to Patients About Diet Without Scaring Them 31:00  Why Vitamin D Deserves a Place in Dentistry 34:00  Vitamin D, Implant Failure and Perio Risk 37:00  Blood Tests as Medico-Legal Defence 42:00  What Dentists Should Test: HbA1c and Vitamin D 44:00  How In-Practice Blood Testing Actually Works 50:00  The Mouth Is the Body: Screening, Not Diagnosing 51:00  Is This Biological Dentistry? An Honest Answer 57:00  How to Learn Blood Testing for Your Practice From the Guest Dr Tif Qureshi qualified from King’s College London in 1992 and is a Past President of the British Academy of Cosmetic Dentistry. He is Founder and Clinical Director of IAS Academy, best known for pioneering Align, Bleach, Bond and Progressive Smile Design, and as a teacher of the Dahl concept. His current focus is metabolic health in general practice. 👉  IAS Academy — Align, Bleach, Bond, the Dahl concept, and blood-testing / metabolic health training Coming soon: Join Dr. Tif in one-day metabolic health programme. He has spent years connecting the dots between what’s happening in the mouth and what’s happening in the body. The results are undeniable: better outcomes, stronger case acceptance, and a rock-solid medico-legal position. This one-day course will change the way you practise. For good.👉Metabolic Health in Dentistry References & Further Reading Studies and sources referenced in this episode: Song I-S, et al. Severe Periodontitis Is Associated with Insulin Resistance in Non-abdominal Obese Adults. J Clin Endocrinol Metab, 2016;101(11):4251–4259. Insulin resistance as an independent risk factor for severe perio in normal-weight adults. Botelho J, et al. Vitamin D Deficiency and Oral Health: A Comprehensive Review. Nutrients, 2020;12(5):1471. Vitamin D across caries, periodontitis, orthodontic and surgical outcomes. Schmolinsky J, Kocher T, Rathmann W, Völzke H, Pink C, Holtfreter B. Diabetes status affects long-term changes in coronal caries – The SHIP Study. Sci Rep. 2019 Oct 30;9(1):15685. doi: 10.1038/s41598-019-51086-z. PMID: 31666549; PMCID: PMC6821733. Want more? If you enjoyed this episode, check out: Why do some Dentists find Dahl Distasteful? – PDP016.  #PDPMainEpisodes #BeyondDentistry #Communication Listen, Subscribe, Earn CPD Listen: Subscribe to the Protrusive Dental Podcast on Spotify, Apple Podcasts, or YouTube. This episode is eligible for 1.0 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes C and A. AGD Subject Code: 730 Oral Medicine, Oral Diagnosis, Oral Pathology Aim & Learning Outcomes Aim: To help dental practitioners understand the link between metabolic health and oral disease, and to evaluate whether simple in-practice biomarker screening has a place in their care of patients. Learning Outcomes — by the end of this episode, dentists will be able to: Describe how disordered glucose and insulin metabolism relates to caries, periodontal disease and healing outcomes, and explain what HbA1c and vitamin D each indicate. Apply a structured, non-alarmist approach to discussing diet and biomarker screening with patients, within the professional boundary of screening rather than diagnosing or prescribing. Evaluate the clinical and medico-legal case for documenting relevant biomarkers before periodontal and surgical treatment, and identify when to refer to a medical colleague.

Filling, stainless steel crown, pulpotomy or extraction — how do you actually decide on a deciduous tooth? Why is the lower first primary molar the one that always seems to flare up? When should you reach for silver diamine fluoride instead of the drill — and when is a child’s cooperation telling you to change the plan entirely? And how do you actually do a pulpotomy, step by step, without it blowing up under the crown? This is a paediatric dentistry masterclass with Dr Nidhi Kotak — “The Baby Tooth Dentist,”. It’s built for the general dentist who treats children and wants clearer rules: when to fill versus crown, how to read the radiograph, silver diamine fluoride, local anaesthetic and behaviour guidance, isolation, and a full pulpotomy and stainless steel crown technique. The through-line is simple — in children you decide fast, protect the airway, and treat for predictability rather than heroics. https://youtu.be/3OscfwF7SIQ Watch PDP274 on YouTube Protrusive Dental Pearl: Strategic Flexibility You cannot be rigid when treating children. The mindset shift is to stop asking “what should be done for this child?” and start asking “what can be done for this child?” With children you have to be fast and efficient, and curveballs are constant — sometimes the parent is harder to manage than the child. So the plan has to bend. The worked example: you planned a conventional prepped stainless steel crown, but cooperation drops mid-appointment. Rather than abandon the visit, switch to a no-prep whole-crown approach and protect the tooth anyway. It stays in the child’s best interest — and it’s far kinder to your own mental health. It’s a mindset worth carrying into all of dentistry, not just children’s. What You’ll Take From This Episode When to fill vs crown — the surface rule for baby molars, why crowns are so predictable in children, and where composites still work. The “D” devil tooth — why the lower first primary molar flares up, and why mesial caries on a D is an automatic crown. Pulpotomy indications — the signs that say vital pulpotomy, the ones that say extraction, and why a pulp exposure in a primary tooth is an automatic pulpotomy. SDF, sedation and isolation — arresting decay without drilling, matching sedation to the child, and protecting the airway. The pulpotomy technique — a full step-by-step from caries removal to cementing the stainless steel crown, including the modern medicament choice. Highlights of This Episode 00:00  TEASER 00:59  Pediatric Dentistry for GDPs: The Strategic Flexibility Mindset 07:24  Why GDPs Struggle Treating Children 08:19  When to Fill vs When to Crown a Baby Tooth 12:18  Class II vs Stainless Steel Crown: The Surface Rule 13:41  Reading Pediatric Radiographs & When to Take Bitewings 19:15  SDF vs Fluoride Varnish: When to Use Each 22:37  Resin Infiltration (Icon) for Children’s Teeth 25:15  Pulpotomy in Primary Teeth: When It’s Indicated 26:19  The “D” Devil Tooth: Why Mesial Caries Means a Crown 27:31  Hall Crowns and the Modified Whole Crown Technique 27:48  Midroll 38:39  Local Anaesthetic & Behaviour Guidance in Children 40:38  Sedation Options: Oral, Nitrous & Intranasal 46:22  Rubber Dam vs Isolite: Isolation for Kids 48:59  How to Do a Pulpotomy: Step-by-Step Technique 58:03  OUTRO Dr Nidhi Kotak is a dual US and Canadian board-certified paediatric dentist — a Diplomate of the American Board of Pediatric Dentistry and a Fellow of the Royal College of Dentists of Canada.  Follow Dr. Nidhi for more paediatric dentistry tips 👉  @babytoothdentist on Instagram Want more? If you enjoyed this episode, check out: Zirconia vs Metal Hall Crowns vs Conventional with Dr Tim Keys – PDP227 #PDPMainEpisodes #EndoRestorative Listen, Subscribe, Earn CPD Listen: Subscribe to the Protrusive Dental Podcast on Spotify, Apple Podcasts, or YouTube. This episode is eligible for 1.0 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes C  AGD Subject Code: 430 Pediatric Dentistry. Aim & Learning Outcomes Aim: To give dental practitioners a clear, decision-led approach to restorative paediatric dentistry — how to choose between filling, crowning, pulpotomy and extraction, how to manage caries conservatively, and how to carry out a pulpotomy and stainless steel crown safely. Learning Outcomes — by the end of this episode, dentists will be able to: Differentiate the presentations that indicate a direct restoration, a stainless steel crown, a vital pulpotomy, or an extraction in the primary dentition, using clinical and radiographic findings. Describe minimally invasive and behaviour-management options in children — silver diamine fluoride, fluoride varnish, resin infiltration, local anaesthesia, sedation and isolation — and select them appropriately for the individual child. Apply a step-by-step technique for a vital pulpotomy and stainless steel crown in a primary molar, including the current choice of medicament and cementation.

How good is your consent for orthodontics — really? More adults are having ortho, and more GDPs are providing it. So which risks should you be discussing with every single patient — and which ones depend on the person in the chair? When a case is heading for a big overjet or a tricky rotation, is that a conversation you have at the start, or one you scramble to explain halfway through? And what actually makes a consent form legally valid — the signature, or everything around it? This episode brings together two perspectives you don’t often hear in the same room. Dr Zaid Esmail is a specialist orthodontist and founder of the Online Orthodontic Academy, who mentors GDPs through fixed and aligner cases. Dr Neel Jaiswal  returns for the dento-legal view — he’s a dentist and the founder of Professional Dental Indemnity (PDI). Together with Jaz, they get very specific about what individualised consent looks like in practice, and how to build a process your patients remember and a court respects. https://youtu.be/YvsiIiX1Q1w Watch PDP273 on YouTube Protrusive Dental Pearl: Make Your Patient Feel Unique It might be your 100th, 500th or 1,000th case — but for the patient in the chair, this is a significant event. Never forget that. A routine extraction is routine for you; for them it’s a big deal, and remembering that makes you a better communicator. To make a specific risk stick, make the patient feel unique. Point to their OPG: “Your sinus here is actually really interesting,” or “Did you know your roots are unusually long?” Patients remember a risk framed as if they’re a special case far better than a generic warning. Make it personal, and the consent becomes memorable. What You’ll Take From This Episode The whole episode turns on one idea: generic, templated consent is no longer defensible — the skill is individualising the form to the patient in front of you. Premium members get the full breakdown; here’s the shape: The layers of valid consent — consent is like an onion; a signed form and a documented conversation each cover a gap the other leaves open. Individualising risk from the records — how the OPG and photos turn a generic warning (resorption, devitalisation, recession, relapse) into a patient-specific one. The two-appointment consent flow — records, individualised risks, thinking time, and why you sign or initial every line. The Class II Div 2 overjet trap — the case that looks like simple crowding and ends in a big overjet, and how to consent for it before you start. When to treat, add an option, or refer — the GDC line on offering all options, and building alternatives into the form. Highlights of This Episode: 00:00  Teaser 01:01  Consent in Orthodontics: Why It Has to Be Individualised 02:59  Protrusive Dental Pearl: Make Your Patient Feel Unique 07:58  What Makes Orthodontic Consent Different 10:08  How Much Ortho Litigation Comes From Consent? 11:53  What Makes Consent Valid and Patient-Specific 12:26  Individualising Ortho Risk from the OPG 13:11  Using the ClinCheck as a Consent Tool 14:40  How to Structure the Consent Appointment 15:30  Root Resorption, Devitalisation, Recession and Relapse 19:37  Should You Initial Every Line of a Consent Form? 21:50  Midroll 27:11  Building a Multi-Layered Consent Process 29:31  Consenting for Fees, Relapse and Retainers 34:41  The Class II Div 2 Overjet Trap 37:51  When Should a GDP Refer an Ortho Case? 40:31  How to Learn Orthodontics with Mentorship 47:01  Outro Dr Zaid Esmail is a specialist orthodontist. He founded the Online Orthodontic Academy to teach GDPs orthodontics — assessment, diagnosis and treatment planning across fixed appliances and aligners — with one-to-one case mentorship. He’s extended a 10% discount to the community with the code PROTRUSIVE. 👉  Online Orthodontic Academy — online ortho mentorship, fixed & aligners, Level 7 Diploma Dr Neel Jaiswal returned for the dento-legal perspective. He’s a dentist and the founder of Professional Dental Indemnity (PDI), which introduces dentists to insurance-based indemnity cover. Request a Quote for Insurance and Get £100 off 👉  Professional Dental Indemnity (PDI) — insurance-based dental indemnity Want more? If you enjoyed this episode, check out: Consent Is Like An Onion – Are You Consenting Your Patients Correctly? – PDP113 Tags #PDPMainEpisodes #OrthoRestorative #Communication  Listen, Subscribe, Earn CPD Listen: Subscribe to the Protrusive Dental Podcast on Spotify, Apple Podcasts, or YouTube. This episode is eligible for 0.5 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes A AGD Subject Code: 565 Documentation & Risk Management  Aim & Learning Outcomes Aim: To help dental practitioners obtain valid, individualised consent for orthodontic treatment — identifying the risks that apply to every patient, tailoring them to the individual, and structuring a consent process that is both comprehensible to the patient and defensible in law. Learning Outcomes — by the end of this episode, dentists will be able to: Describe the elements that make orthodontic consent valid and patient-specific, including the material-risk standard and the role of reasonable alternative treatments. Apply a structured, multi-layered consent process — individualising risk from the clinical records and documenting the discussion — to an individual orthodontic patient. Identify the case types and clinical situations that warrant additional consent, an alternative option, or onward referral to a specialist.

Ever fancied teaching dental students part time… but no real idea how you’d actually get in? Are you the kind of person teaching would energise — or quietly drain? Is a PGCert in dental education actually worth it, or just wishy-washy theory? And the honest question nobody asks out loud: does it pay anything? This is an Interference Cast — the non-clinical arm of the podcast — with Dr Rima Hussain, a general dentist who teaches restorative dentistry to undergraduates at King’s a couple of days a week. It’s a candid look at what a career in dental education actually involves: how to get in, who thrives and who burns out, what the work is really like, and the honest truth about the pay and the rewards. The bigger theme: dentistry is a career you can mould in endless directions — and for the right person, teaching is one of the most energising of them. https://youtu.be/DzmcM-SbD68 Watch IC076 on YouTube What You’ll Take From This Episode The full self-assessment and the step-by-step route into a teaching role are in the Premium Notes. Here’s the shape of what we cover: Are you built for the classroom? — the two-camp self-check (energised vs drained) that predicts whether teaching will recharge you or wear you down. How to actually land a role — the ‘BDJ Jobs’ plus pick-up-the-phone route, and why “who you know” so often cuts through the application process. Relatability as a strength — why being closer to a student’s level can beat decades of experience for an absolute beginner. Back to basics — the “monkey see, monkey do” risk from YouTube and AI, and what the tutor’s real job becomes. The honest pay-and-balance picture — why you don’t do it for the money, what you do get, and how teaching and practice keep each other fresh. Highlights of This Episode 00:00  Teaser 01:08  Should You Teach Dentistry? How to Know If It’s for You 04:39  How a General Dentist Gets Into Dental Education 06:15  Signs You’re Suited to Teaching Dentistry 08:52  Is a PGCert in Dental Education Worth It? 12:07  How to Land a Clinical Teaching Post at a Dental School 14:38  Why a Relatable Tutor Beats Decades of Experience 16:52  How Dental Students Have Changed Since COVID 19:20  Is Social Media and AI Helping or Hurting Dental Students? 21:55  Midroll 26:43  Why “Back to Basics” Beats Chasing Advanced Techniques 29:20  How to Get a Teaching (or Associate) Job: Pick Up the Phone 31:50  Why Dental Tutors Quit After Six Months 36:29  The Most Rewarding Part of Teaching Dentistry 38:46  Teaching, Practice and Pay: How to Avoid Burnout 44:39  Outro From the Guest Dr Rima Hussain is a general dentist who also teaches restorative (conservative) dentistry to undergraduates at King’s College London — a route she fell into via tutoring as a teenager and has been in since 2019. Her advice for anyone curious: you’re probably already teaching in some form, so try it; the worst case is you find it isn’t for you. 👉  Reach Rima on Instagram References & Further Reading Mentioned in this episode: Rath T. StrengthsFinder 2.0. Gallup Press, 2007. The strengths-assessment book referenced for the “Learner” theme and the idea of building your career around your natural strengths. “Learner” is one of its 34 themes; the assessment is now delivered as CliftonStrengths. BDJ Jobs. The British Dental Journal jobs board where clinical tutor and academic posts are advertised, usually with short application windows. Want more? If you enjoyed this episode, check out: 2 Years Out of Dental School – Insights for New Grads – IC066 #InterferenceCast #CareerDevelopment #BeyondDentistry Listen, Subscribe, Earn CPD 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  Aim & Learning Outcomes Aim: To help dentists evaluate a part-time career in dental education — what the role involves, how to obtain one, and how to sustain it alongside clinical practice. Learning Outcomes — by the end of this episode, dentists will be able to: Identify the personal attributes and expectations that distinguish dentists who thrive in clinical teaching from those who do not. Describe the practical routes into a dental-school teaching post, including where posts are advertised and how a direct, proactive approach can work. Recognise the workload, financial and work-life-balance realities of part-time teaching, and strategies to avoid burnout while balancing teaching and practice.

Sleep, Airway and Mouth Breathing: An ENT’s Guide for Dentists Could a “normal” sleep study still be missing your patient’s airway problem? Why do women and children with real symptoms keep scoring “mild”? Should a mouth-breathing child see a myofunctional therapist — or an ENT first? And which four questions screen a child for sleep problems in under a minute? The roof of the mouth is the floor of the nose — so ENT and dentistry should be in constant dialogue. In practice, they rarely are. In this one, Dr David McIntosh — an Australian ear, nose and throat surgeon with a deep niche in sleep-disordered breathing — makes the case for why that has to change, and gives dentists practical ways to screen and refer. He is direct, analogy-rich and doesn’t mince words; expect a few positions that cut against the grain of how sleep apnoea is usually handled. https://youtu.be/QVEc0ocxTCc Watch PDP272 on YouTube Protrusive Dental Pearl: When the Numbers Mislead Dentists love data — the AHI, the cut-offs (over 5 is mild, over 30 is severe). But take those numbers with a pinch of salt: the thresholds are arbitrary, and a single score tells you nothing about why a patient has the problem. They don’t account for individual variability — especially in women and children, where a mild score can sit right alongside significant symptoms. Read the number with the anatomy and the phenotype — the clinical signs and the airway assessment — never instead of them. What You’ll Take From This Episode This conversation reframes sleep-disordered breathing from a number on a report into something you can localise and refer.  A sleep study tells you IF, not WHY — sleep-disordered breathing is the whole spectrum; a normal study doesn’t mean normal breathing. Phenotyping the airway — map the individual anatomical causes instead of trusting a single score. Why women get missed — the gender bias built into standard adult screening tools, and what to ask instead. The four-question filter for children — snore, mouth breathe, stop breathing, wake up tired: any ‘yes’ means refer. Treat the cause before the function — why myofunctional therapy comes after the obstruction is cleared, not before, and how expansion and surgery are matched to the anatomy. Highlights of This Episode 00:00  Teaser 01:00  Why ENT and Dentistry Should Be Talking 02:51  Protrusive Dental Pearl: When Sleep Data Misleads You 03:46  Meet the ENT Who Works With Dentists 06:00  Sleep Physician, ENT or Dentist: Who Should Lead? 07:26  Why Children and Adults Are Completely Different 08:58  Sleep-Disordered Breathing Is Not the Same as Sleep Apnoea 09:39  Why a Normal Sleep Study Doesn’t Mean Normal Breathing 10:01  Same AHI, Different Cause: A Tale of Two Patients 12:54  Why One Night’s Sleep Study Isn’t Enough 13:44  Where the AHI Cut-Off Numbers Really Came From 15:27  CPAP Explained: A Bridge, Not a Cure 18:27  When Snoring Hides Something Serious 19:10  What Phenotyping the Airway Actually Means 20:27  Splint, CPAP, or Both? 21:33  Why a CBCT Can Miss a Deviated Septum 25:32  Is STOP-Bang Enough to Screen for Sleep Apnoea? 26:06  Why the Epworth Sleepiness Scale Is a Blunt Tool 26:50  Why STOP-Bang Is Biased Against Women 31:17  Sleep Apnoea in Women: Mild on Paper, Severe in Life 32:05  Midroll 36:56  The Triad: Airway, TMD and Orthodontics 37:12  The Three Most Common Causes of Night-Time Grinding 39:41  The Four Questions That Screen a Child for Sleep Problems 41:03  Tired vs Not Tired: The Sign That Changes Everything 43:36  Should You Refer to Myofunctional Therapy Before an ENT? 45:58  The Hidden Dangers of Forcing Nasal Breathing 52:28  Maxillary Expansion vs Surgery: Which One Fixes It? 54:51  How Dentists Can Assess Adenoids 56:25  Save the Child First: The Drowning Analogy 57:56  Where Dentistry and ENT Go From Here 1:00:05  Outro – New-Look Premium Notes & CPD Outro From the Guest Dr David McIntosh is an ear, nose and throat surgeon (MBBS, FRACS, PhD) with a special interest in sleep-disordered breathing and airway obstruction. A self-described compulsive educator, he is the author of several books on Amazon — including dENTal health, on the connection between ENT and dental disease, and Snored to Death, on the lesser-recognised causes of obstructive sleep apnoea in adults. References & Further Reading Sources discussed in this episode: Chervin RD, Hedger K, Dillon JE, Pituch KJ. Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Medicine, 2000;1(1):21–32. The 22-item PSQ; a score above 0.33 suggests sleep-disordered breathing. Loved This Episode? Try Next Airway Dentistry with Jeff Rouse – PDP229 Listen, Subscribe, Earn CPD This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes C AGD Subject Code: 730 – Oral Medicine, Oral Diagnosis, Oral Pathology (Sleep medicine) #PDPMainEpisodes #OralSurgeryandOralMedicine Aim & Learning Outcomes Aim: To help dental practitioners recognise sleep-disordered breathing across the whole airway, screen adults and children appropriately, and refer at the right time and to the right clinician. Learning Outcomes — by the end of this episode, dentists will be able to: Differentiate sleep-disordered breathing from obstructive sleep apnoea, and explain why a normal sleep study does not exclude clinically significant breathing problems. Apply a structured screening approach for adults and children, including recognising why standard adult tools under-detect sleep-disordered breathing in women and children. Evaluate when to refer for specialist airway assessment, and articulate why addressing anatomical obstruction should precede functional (myofunctional) therapy.

The most important part of your surgery isn’t plugged in, mounted, or calibrated. It’s the person standing beside you. Have you ever dreaded walking into a beautiful practice with lovely patients — purely because of who you share the surgery with? What do you actually do, in the moment, when your assistant rolls their eyes at a request for rubber dam? And should you be friends with your assistant at all — or does that cross a line you’ll regret? This is an Interference Cast — a non-clinical but deeply practical episode — with Dr. Sarah Braun, a dentist in Australia and a fellow Protrusive Guidance member who DM’d to suggest this very topic. No course, no book, nothing to sell: just two clinicians comparing notes (and the odd scar) on the one relationship that quietly shapes your whole working life. It sits inside this month’s theme of the relationships that support your career. https://youtu.be/OyztRyPpcHM Watch IC075 on YouTube What You’ll Take From This Episode The full breakdown is in the Premium Notes; here’s the shape of the thinking that runs through the episode: Engagement is the whole game — the assistant relationship sets the mood of the room, the patient’s experience, and whether good people stay. Speak their language — appreciation only lands if it’s delivered in the form that particular person actually values. Appreciation is a verb — specific, named praise lands far harder than a vague “good job.” Let them, let me — you don’t control how someone reacts in the moment; you only control your response to it. Lead the room — dentistry is a performance, and the room takes its emotional cue from whoever is leading it. Highlights of this episode: 00:00 TEASER01:13 Why This One Relationship Can Make or Break You03:49 A Non-Clinical Interference Cast: What to Expect04:47 Meet the Guest: Nine Years In, City to Country07:01 A Week in Private Practice09:15 How Much Does the Dentist–Assistant Relationship Matter?11:01 Engagement at Work: The Gallup Lens12:30 People Remember How You Made Them Feel14:21 When the Relationship Turns Toxic15:23 The Power Imbalance You Might Not See18:11 The First-Day Conversation20:52 Keeping Your Assistant Engaged22:23 Specific Praise Beats a Vague “Good Job”23:55 Midroll27:37 You Can Only Control Yourself29:34 The Eye-Roll Moment: Let Them, Let Me31:23 Off Days vs Patterns32:12 Appreciation, Gifting & Speaking Their Language35:32 Run the Relationship Like It Matters36:48 Friends With Your Assistant, or Keep Your Distance?39:08 A Best Friend at Work: The Engagement Link41:15 Advice for New Grads: Start With Time Management44:26 Teaching as a Tool: Show Your Working Out48:05 Wrap-Up & a Healthy Debate48:37 CPD Outro & the Protrusive Vault References & Further Reading: Sources and further reading from this episode: Chapman G. The Five Love Languages. Northfield Publishing, 1992. The five ways people give and receive appreciation — words of affirmation, quality time, acts of service, receiving gifts, and physical touch — applied here to the dentist–assistant relationship. Robbins M, Robbins S. The Let Them Theory. Hay House, 2024. The “let them / let me” reframe for releasing what you can’t control and owning your own response. Rath T. StrengthsFinder 2.0. Gallup Press, 2007. The CliftonStrengths assessment; “Learner” is one of its talent themes, referenced in the discussion of teaching as a way to engage your assistant. Gallup employee-engagement research. The Gallup Q12 engagement survey (including the validated “I have a best friend at work” item) and Gallup’s State of the Global Workplace reports. Source of the workforce-engagement framing in this episode. Exact figures vary by year — see Reviewer Note. Want more? If you enjoyed this episode, check out: How to Find a Mentor in 5 Seconds Flat! – IC058.  #InterferenceCast #CareerDevelopment #Communication #BeyondDentistry Listen, Subscribe, Earn CPD: This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes A and B AGD Subject Code: 550 Practice Management and Human Relations Aim & Learning Outcomes: Aim: To help dental practitioners understand and strengthen the working relationship between dentist and dental assistant — recognising its impact on team engagement, patient experience and personal job satisfaction, and building practical habits to improve it. Learning Outcomes — by the end of this episode, dentists will be able to: Explain how the working relationship between a dentist and a dental assistant affects team engagement, the patient experience, and clinician wellbeing. Identify practical strategies for communicating appreciation and recognition in ways suited to the individual, and for involving an assistant according to their preferences. Apply self-management and emotional-regulation approaches to leading the surgery and responding constructively to interpersonal friction.

Is rotary really better than reciprocating? Can you safely skip the glide path with modern reciprocating systems? What is the best file system for a GDP who wants predictable endodontic results? And perhaps the biggest question of all: does the file system matter as much as we think it does? In Part 2 of the Endo Showdown, Dr Samuel Johnson returns to tackle some of the most common questions dentists have about file systems, glide path preparation, retreatment, and endodontic workflow. From practical negotiation tips to choosing a system that works in your hands, this episode focuses on the decisions that can make endodontics simpler, safer, and more predictable. https://www.youtube.com/watch?v=onZMR-872HQ Watch PDP271 on YouTube Protrusive Dental Pearl Cut your gutta-percha at the level of the canal orifice and thoroughly clean the pulp chamber before placing the coronal restoration. ⚠️ Leaving gutta-percha and sealer coronally can compromise the coronal seal and promote leakage. ✅ Use isopropyl alcohol to clean resin-based sealer residue before bonding. Water is effective for cleaning bioceramic sealers. Key Takeaways Establish a glide path before shaping whenever possible. D-Finders can negotiate difficult canals more predictably than traditional K-files. Intermediate files such as size 12 or 12.5 can help bridge the jump from size 10 to size 15. Straight-line access reduces file binding and improves shaping efficiency. Avoid forcing glide path files to working length. Gates Glidden drills may be unnecessarily aggressive for routine coronal flaring. Consistency with one file system is often more important than chasing the latest product. WaveOne Gold remains a simple and user-friendly option for many GDPs. Rotary and reciprocating systems can both achieve successful outcomes when used appropriately. A good glide path is often more important than the type of motion being used. Hand files and Hedström files remain valuable during retreatment. Mechanical GP removal near the apex increases the risk of extrusion. Solvents are best reserved for residual gutta-percha rather than used at the start of retreatment. Understanding motor settings, torque, and RPM improves file safety and efficiency. Knowing when to refer is a sign of clinical maturity, not weakness. Clear consent and expectation management reduce stress for both clinician and patient. Highlights of this episode: 00:00 Teaser 01:09 Introduction 02:15 Protrusive Dental Pearl: Coronal GP Removal & Pulp Chamber Clean-Up 03:59 Glide Path File Protocol & Canal Negotiation 06:24 Access Cavity Design & Coronal Flaring in RCT 08:38 File Taper & Canal Preparation Philosophy 09:54 Managing Difficult Canals in Endodontic Treatment 11:48 When to Introduce the Glide Path File 13:24 Using Intermediate File Sizes 15:39 Useful Negotiation & Shaping Tips 17:19 Choosing a File System 20:19 Rotary vs Reciprocating in Clinical Practice 21:29 Motor Settings & File Control 21:40 XP-Endo & Specialised File Designs 22:05 Endo Motor Ads 24:44 XP-Endo & Specialised File Designs 25:16 Retreatment Files & GP Removal 26:08 Preferred Gutta-Percha Removal 31:21 Recommended System for Simplicity 32: 44 Building Skills Faster in Endodontics 36:13 Consent & Managing Expectations 41:51 Reciproc vs WaveOne Gold 42:22 Preferred Retreatment Protocol 43:33 Using Rotary Files in Reciprocation 45:12 Curved Canals & Shaping Efficiency 46:32 Can Reciproc Blue Bypass the Glide Path? 49:29 Outro Want more? Check out the previous episode with Dr. Samuel Johnson: Working Lengths and Troubleshooting Apex Locators – PDP216 🦷 Looking for an endomotor? Upgrade your endodontic workflow with the Woodpecker Endo Radar Pro. Head to protrusive.co.uk/endomotor and use coupon code PROTRUSIVE at checkout to claim an exclusive discount and your choice of complimentary file system. 🎁 Subscribe to Dr. Samuel Johnson’s amazing YouTube Channel: I Love The Pulp for more helpful endodontics tips and tricks.  #PDPMainEpisodes #EndoRestorative This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes C AGD Subject Code: 070 – Endodontics Aim: To enhance clinicians’ understanding of glide path preparation, rotary and reciprocating instrumentation, canal negotiation, retreatment strategies, and risk management in contemporary endodontic practice. Dentists will be able to – Dentists will be able to evaluate the role of glide path preparation in improving shaping efficiency and reducing procedural errors. Dentists will be able to compare practical considerations when using rotary and reciprocating file systems. Dentists will be able to apply safe and predictable approaches to canal negotiation, retreatment, and clinical decision-making.

Rotary or reciprocating files — which should you actually be using? Is one safer than the other? Does reciprocation really reduce file separation? Are you choosing your system because it suits the canal anatomy, or because it is simply the one you were taught? Endodontic file systems can feel like a maze of brands, tapers, alloys, motions and marketing claims. But beneath all that noise, the real question is much more practical: what is your file doing inside the canal, and what compromise are you accepting? In this episode, Dr Samuel Johnson returns to unpack the Endo Showdown: rotary versus reciprocating files. We cover file motion, glide paths, shaping philosophy, NiTi metallurgy, cyclic fatigue, torsional fatigue, and why no system is perfect. https://youtu.be/HfWDBbNgjsA Watch PDP270 on YouTube Protrusive Dental Pearl A palliative root canal can be useful for an unrestorable tooth if disinfecting the canal allows infection to heal and natural bone to recover before extraction and future implant planning. ⚠️ Do not dismiss root canal treatment purely because the tooth is not a long-term functional restoration. ✅ Where appropriate, consider whether endodontic disinfection could improve the future implant site by allowing natural bone healing. Key Takeaways The purpose of shaping is not simply to scrape canal walls; it is to create space for irrigant flow. Irrigation is the most important part of root canal disinfection. Rotary files move in a continuous 360-degree rotation. Reciprocating files cut in one direction and reverse before excessive stress builds up. Modern reciprocation is designed to cut, release and gradually progress apically. File choice is not just about motion; metallurgy, taper, design and operator experience all matter. NiTi hand files with strong shape memory may be problematic in curved canals because they want to straighten. Martensitic heat-treated files are more flexible and can better follow canal curvature. Unwinding flutes are a warning sign that a file may be close to separation. Inspect files regularly during treatment, especially in curved, calcified or difficult canals. A glide path is essential before introducing larger rotary or reciprocating files. Without a glide path, a shaping file may create its own path, risking ledging, transportation or perforation. “Grabby” files pull themselves into the canal; this can be useful in experienced hands but risky if forced. Reciprocating systems can feel simpler and safer, but they are not foolproof. Cyclic fatigue happens when a file repeatedly bends around a curve until microcracks form. Torsional fatigue happens when part of the file binds while the motor continues to turn. Highlights of the episode: 00:00 Teaser 00:47 Introduction 02:13 Protrusive Dental Pearl: Palliative Root Canal Treatment 05:30 Main Question: Rotary vs Reciprocating Files 06:31 Hybrid File Motions 08:19 File Choice Is More Than Motion 10:26 Purpose of Shaping in Endodontics 11:10 Chemo-Mechanical Preparation 11:34 Rotary Motion in Root Canal Treatment 11:45 Origins of Reciprocation 12:21 Balanced Force Technique 18:00 NiTi K-Files vs Stainless Steel K-Files 22:37 Practical Advice: Inspect the File 23:40 Rotary Can Also Be a One File System 24:24 Reciprocation and Sense of Safety 24:47 “Grabby” Files 24:53 Midroll 33:54 Choosing Between Rotary and Reciprocating 35:20 Cyclic Fatigue 37:41 Endo Radar Pro Ads 40:20 Torque and RPM in Endodontics 41:41 Why Reciprocation Advances 42:56 Debris Extrusion in RCT 43:34 Benefits of Rotary Systems 44:13 Tactile Feedback in Root Canal Treatment 45:21 Outro Want more? Check out previous episode with Dr. Samuel Johnson: Working Lengths and Troubleshooting Apex Locators – PDP216 🦷 Looking for an endomotor? Upgrade your endodontic workflow with the Woodpecker Endo Radar Pro. Head to protrusive.co.uk/endomotor and use coupon code PROTRUSIVE at checkout to claim an exclusive discount and your choice of complimentary file system. #PDPMainEpisodes #EndoRestorative This episode is eligible for 0.5 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes CAGD Subject Code: 070 Endodontics Aim: To improve dentists’ understanding of rotary and reciprocating endodontic file systems, including file motion, glide path creation, file metallurgy, fatigue mechanisms, irrigation principles, and practical steps to reduce procedural risks. Dentists will be able to – Understand the clinical differences between rotary and reciprocating file motions and how these may influence endodontic workflow Recognise key risk factors for file separation, including cyclic fatigue, torsional fatigue, file distortion and inappropriate file use Apply practical principles around glide path creation, irrigation, file inspection and system selection in endodontic treatment

Should we still be drilling early caries lesions? Where do peptides, resin infiltration, fluoride varnish and SDF actually fit in modern practice? Is hydroxyapatite toothpaste a genuine alternative to fluoride, or just another dental trend? And when you see that suspicious grey occlusal shadow, do you seal it, explore it, or actively surveil it? In part two of this modern caries management episode, Jaz continues the conversation with Prof. Avijit Banerjee on minimal intervention dentistry. This episode moves beyond diagnosis and communication into the practical management of early and progressing caries lesions, including peptides, SDF, hydroxyapatite toothpaste, fissure sealing, xerostomia, root caries and selective caries removal. https://youtu.be/dGt7FW7C4N0 Watch PDP269 on YouTube Protrusive Dental Pearl Use the Contemporary Caries Management Implementation Pack as a chairside aid to turn the episode into daily clinical action. ⚠️ Learning the evidence is not enough if it never makes it into your patient conversations, risk assessment or treatment planning. ✅ Print it, laminate it, and use it to support communication, diagnosis, active surveillance and minimally invasive decision-making. Disclaimer: This is an educational resource produced by Team Protrusive, derived from the two-part Protrusive Dental Podcast episode featuring Prof. Avijit Banerjee. Its contents were not written, reviewed, or endorsed by Prof. Banerjee; they represent Team Protrusive’s own interpretation of the material discussed. It is intended as a practical summary and is not a substitute for primary sources. We strongly encourage all clinicians to consult the latest Clinical Practice Guidelines before making treatment decisions. Key Takeaways: Peptides are designed to infiltrate early enamel lesions and create a scaffold for mineral deposition. Peptide technologies still need minerals from saliva, toothpaste, mouthwash or other sources to work. Fluoride supports remineralisation; it acts more like the “mortar” than the “bricks”. Early E1 lesions are usually managed with prevention, fluoride, oral hygiene, diet control and biofilm control. Deeper enamel lesions, such as progressing E1 or E2 lesions, may be suitable for resin infiltration or peptide infiltration. SDF is better suited to cavitated lesions where arrest and stabilisation are needed. In the UK, SDF is licensed for dentine sensitivity, so caries arrest is an off-label use. SDF can be very useful for children, older adults, medically compromised patients and care-home patients. The main downside of conventional SDF is black staining, especially on anterior teeth. Hydroxyapatite toothpaste has more science behind it than charcoal-style fad toothpastes. Fluoride toothpaste remains the preferred baseline recommendation when patients are happy to use fluoride. A suspicious grey occlusal lesion should be assessed in the context of the patient’s overall caries risk. In selected cases, a tiny exploratory opening can act like a diagnostic biopsy. Sealing fissures on the same tooth being restored can be sensible when the fissure pattern is deep. For severe xerostomia and root caries risk, consider high-fluoride regimes, close recalls, trays or dentures as carriers for remineralising agents. YouTube Highlights: 00:00 Teaser 01:17 Introduction 02:17 Pearl: Caries Management Implementation Pack 05:54 What are Peptides? 14:42 SDF: Silver Diamine Fluoride 14:55 Early Enamel Lesion Pathway 15:11 When to Consider Resin or Peptide Infiltration 15:51 Best Use Case for SDF 20:14 Hydroxyapatite Toothpaste 21:18 Fluoride Safety and Evidence 27:00 Midroll 40:53 Preventive vs Therapeutic Sealants 42:09 Severe Xerostomia and Root Caries 44:40 Using Trays or Dentures as Carriers 45:48 Tooth Mousse and CPP-ACP 47:11 Artificial Saliva 47:46 Why the Patient Has Dry Mouth Matters 49:35 Current Position on Stepwise Excavation 50:09 Selective Caries Removal 51:15 Deep Caries Guidelines 53:01 Materials Are Not Everything in Caries Management 55:59 Further Learning Resource  56:44 Outro Want more? Check out part one of this modern caries management series for communication, diagnostics, triangulating data and deciding which caries detection tools are actually worth using. 🦷 Download the Contemporary Caries Management Implementation PackHead to protrusive.co.uk/MID to access the free implementation pack, including key communication points, diagnosis guidance, management flowcharts and evidence links. Professor Avijit Banerjee’s recommended reading and ongoing work: New textbook: A Clinical Guide to Advanced Minimum Intervention Restorative Dentistry (Banerjee A., Elsevier, 2024) — the most comprehensive single reference for modern MIOC and MID. 👉  uk.elsevierhealth.com (ISBN 978-0-443-10971-3) Resources mentioned in this episode: S3 Guidelines: https://pmc.ncbi.nlm.nih.gov/articles/PMC13099699/  🦷 Interested in Proximal Resin Infiltration? Explore The Iconic Method with Cat Edney: a free 1-hour webinar on 24 June 2026, followed by a hands-on 1-day Birmingham course on 4 July 2026 covering Icon resin infiltration, tooth whitening and NIRI-guided enamel management, with verifiable CPD available.  Don’t miss out!DMG Icon Proximal discount for dental professionals at protrusive.co.uk/dmg #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 (Restorative) Dentistry Aim: To improve dentists’ confidence in modern minimal intervention caries management by applying risk-based decision-making, active surveillance, appropriate use of remineralising and arresting therapies, and evidence-informed restorative strategies. Dentists will be able to – Assess early and progressing caries lesions using patient risk, clinical signs, symptoms and radiographic findings. Select appropriate non-operative, microinvasive and stabilisation strategies, including fluoride, peptides, resin infiltration, sealants and SDF. Manage high-risk patients, including those with xerostomia or root caries risk, using prevention, recall planning and patient-specific delivery methods.

If you showed the same bitewing to 10 dentists, would they all agree on whether to pick up the drill? Why does the word monitoring mean nothing to a patient — and how does swapping it for active surveillance change everything from your notes to your indemnity to your government policy meetings? Is it overtreatment to act on an E2 lesion — or is “watch and wait” actually the lazy answer dressed up as minimally invasive? And what should you actually do with AI caries detection that flags shadows your eye doesn’t see? In this episode, Professor Avijit Banerjee — Professor of Cariology & Operative Dentistry at King’s College London, Honorary Consultant at Guy’s & St Thomas’, and First Dean of the Faculty of Dentistry at the College of General Dentistry — sits down with Jaz for what is genuinely one of the most important caries conversations on the podcast. Part one of two. Avijit doesn’t do soft answers. The drill-fill-bill model is broken. “Monitoring” needs to go. “Treatment planning” is antiquated terminology medics dropped twenty-five years ago. And AI in caries diagnosis? Useful — but the moment it gets things wrong, you are the one with indemnity, not the software. What you walk away with is a framework (MIOC), a decision filter (three factors that decide whether to pick up a bur), and a vocabulary shift you can implement tomorrow. Part two covers peptides, SDF, hydroxyapatite, stepwise excavation, and managing caries in xerostomia. https://youtu.be/YriLo8_hXNw Watch PDP268 on YouTube Protrusive Dental Pearl: Delete the Word “Monitor” from Your Vocabulary Stop saying monitor. Start saying active surveillance. ⚠️ Active surveillance must not mean passive delay — document your reasoning, risk assessment, and what would trigger intervention. ✅ Explain it to patients as structured, proactive care: clinical checks, radiographs, risk review, behaviour support, and timely action if things change. Key Takeaways Minimum intervention oral care is bigger than minimally invasive dentistry. MIOC is prevention-based, person-focused, susceptibility-related, and delivered by the whole oral healthcare team. MID is only one part of MIOC: operative dentistry when a tooth actually needs intervention. The four MIOC domains are: identify the problem, prevent lesions and control disease, provide minimally invasive operative care, then reassess. A care plan is more useful than a treatment plan because it includes justification, prevention, behaviour change, and review. Ask patients what matters to you, not just what’s the matter with you. Cavitation, cleansability, and lesion activity should guide whether to intervene operatively. A cavitated lesion that cannot be cleaned is much more likely to remain active. Smooth surface lesions may sometimes be made cleansable without conventional drilling. Restorations are not just about filling holes; they help recreate a cleansable tooth surface. There is no single perfect caries detection technology — clinical examination and good radiographs remain fundamental. If using NIRI, fluorescence, scanners, or AI, understand how the technology works and where it fails. AI should support diagnosis, not replace clinical judgement. For uncertain early lesions, triangulate: clinical findings, radiographs, risk, technology, and patient factors. Proximal resin infiltration has a role in the right patient and situation, especially as part of a wider prevention-led strategy. Highlights of This Episode 00:00 Teaser 02:17 Protrusive Dental Pearl: Active Surveillance, Not Monitoring 09:14 Minimum Intervention Oral Care vs Minimally Invasive Dentistry 11:28 Core Principles of MIOC 11:48 Domain 1: Identify the Problem 12:46 Domain 2: Prevention of Lesions and Control of Disease 13:18 Microinvasive Care Options 14:41 Domain 3: Minimally Invasive Operative Dentistry 16:38 Why “Active Surveillance” Matters 18:24 MIOC as a Practical Framework 19:43 Applying MIOC in Patient Communication 22:38 Sustainability & Salutogenesis 29:05 When to Pick Up a Drill 30:23 Biofilm as the Engine of Caries 31:33 Purpose of a Restoration in Caries Management 36:13 Caries Detection Technologies 42:44 Watch and Wait vs Detect and Manage 01:02:52 Outro Professor Avijit Banerjee’s recommended reading and ongoing work: New textbook: A Clinical Guide to Advanced Minimum Intervention Restorative Dentistry (Banerjee A., Elsevier, 2024) — the most comprehensive single reference for modern MIOC and MID. 👉  uk.elsevierhealth.com (ISBN 978-0-443-10971-3) 🦷 Interested in Proximal Resin Infiltration? Don’t miss out! DMG Icon Proximal discount for dental professionals at protrusive.co.uk/dmg Explore The Iconic Method with Cat Edney: a free 1-hour webinar on 24 June 2026, followed by a hands-on 1-day Birmingham course on 4 July 2026 covering Icon resin infiltration, tooth whitening and NIRI-guided enamel management, with verifiable CPD available.  Loved This Episode? Try this next: Is Caries Detector Dye BS? – PDP138 #PDPMainEpisodes #BreadandButterDentistry  Listen & Earn CPD This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance. This episode meets GDC Outcomes A and C AGD Subject Code: 250 Operative Dentistry (Caries Detection and Prevention) Aim & Learning Outcomes Aim: To equip dental practitioners with a contemporary, evidence-informed framework for the diagnosis and non-operative or minimally invasive management of dental caries — with a particular focus on the decision-making that determines whether operative intervention is justified. Learning Outcomes — by the end of this episode, dentists will be able to: Describe the four underpinning principles and four clinical domains of Minimum Intervention Oral Care (MIOC), and articulate the difference between MIOC and minimally invasive dentistry. Apply a structured decision filter — incorporating cavitation, cleansability, and lesion activity — to determine whether a carious lesion requires operative intervention or microinvasive/non-operative management. Differentiate between passive monitoring and active surveillance, and use appropriate language in clinical communication, care planning, and contemporaneous notes