Dentistry Uncensored with Howard Farran
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1330 Dr. Geoff Sharpe on Referral Models and Saving Teeth : Dentistry Uncensored with Howard Farran

1330 Dr. Geoff Sharpe on Referral Models and Saving Teeth : Dentistry Uncensored with Howard Farran

1/10/2020 3:00:00 AM   |   Comments: 2   |   Views: 226
Dr. Geoffrey Sharpe grew up in the north of England and graduated from Newcastle University School of Dental Sciences in 1998 with distinction in Restorative Dentistry. In 2010, Dr. Sharpe was invited to join a renowned clinic in Dubai as their in-house periodontist. He held this role for seven years prior to creating The Perio Clinic in 2017. Until recently, he also held a part-time role at Mohammed Bin Rashid University in Dubai where he enjoyed teaching and mentoring the next generation of periodontists. Dr. Sharpe lives in Dubai with his wife, Kim, and their one-year old son, William. In their free time, they enjoy early mornings at the beach, camping in the desert and exploring travel opportunities from Dubai.

VIDEO - DUwHF #1330 - Geoff Sharpe

AUDIO - DUwHF #1330 - Geoff Sharpe

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Howard: it's just a huge honor for me today to be podcast interviewing my buddy Dr. Geoffrey Sharpe who was born and raised in the north of England he graduated from Newcastle University School of Dental Sciences with distinction in restorative dentistry he subsequently worked in the NHS as a senior house officer at Aberdeen Royal in for me in Manchester Royal and for me gaining experience in restorative dentistry and oral maxillofacial surgery before proceeding to full-time general practice he later returned to Newcastle University for specialist training in periodontics he graduated with a clinical master's degree in achieve membership in restorative dentistry periodontics at the Royal College of Surgeons at Edinburgh he was invited to Dubai in 2010 and became the periodontist at a renowned specialty clinic prior to creating the perio clinic doctors ship Sharpe lives in jamario with his family and their free time they enjoy early mornings at the beach camping in the desert and exploring travel operations to Dubai thank you so much for coming on the show today well the first thing I want to talk about I mean pair of the ten specialties periodontics was turned upside down the most but before I go there you're a very rare bird only 1% of humans at a 8 billion are living today in a country they weren't born in and you were you know from England and you went to another country usually you go to another country for love or a job and and you took did you meet your wife in England or did you meet her in Dubai or tell us the story how how did you go from England at what what is that ten thousand miles away from divided England maybe not quite as bad but 

Dr. Geoffrey Sharpe: what happened was and I mean you read my bio thank you  may be sound and probably better than I really am but I spent my whole life in the north of England prior to coming in here and you know the private dental market in that region was relatively small and what I found was in order to keep busy doing and doing the job that I loved I was working part-time a number of different clinics you know I was all over the place that was during a day here a day for somebody else periodontist but I found I was making life difficult and the whole thing was  quite inefficient had some fantastic mentors and there just happened to be there was an American periodontist who was about to retire from his role and replacement and I thought maybe maybe help me out for a couple years while I save up and you know and get on the tractor buying my own business so I can't I met my colleagues an amazing place it's it's totally unique we can detail but at that time to be honest ended really seal the deal for me was the fact that I was gonna take over from an existing periodontist for a long time he had a patient base he had a referral base and for the first time I could come to work in the same room see my patients have control of the environment and have my best in the corner and just focus on doing a good job 

Howard: so I did another podcast with a gentleman who practice in two pi Michael app' he has an office in New York and buy so you hang out with a long time

Dr. Geoffrey Sharpe:  I think of the back I know it's it's a different lifestyle you know I you know I had to do all those long-distance flights all the time and what I decided right out the gate tha

Howard: t I wasn't gonna listen to music and I wasn't gonna watch movies and I was going to whenever I saw like a nice eight Paige textbook you're like well that's a perfect 15 hour flight and so I think about it I buy the textbook I did and because when you're at home it's just so hard to get in the zone for those many hours but but that's neat you you're you went where the money was I mean you you you saw more economic opportunity in another country I dealt with this for four three decades in America you know some kid born in a town of 5,000 that the factory closed now the town's 2,500 and he's asking me how to grow his business and I'm like you do know you can move right and people just it's romantic they want to go down with her ship you know what I mean and I just think it's so cool that a guy like you can think outside about so then you met your wife there to community

Dr. Geoffrey Sharpe:  two years three years back to the UK and you know that time just goes so fast and I mean I'm gonna be here ten years next year and as I said she's a teacher she's Canadian sources from different countries and so we had a conversation we sat down and Dubai you know we both love it here it's kind of neutral territory I think there might be challenges for me to jump through all the hoops to to actually practice in Canada so yeah we said why don't we make a go of it let's let's open a clinic here for supporting as well we did all of that my old days are spent just you know up to my eyes in um and contractors and building and ordering stuff and when Kim just you know she's my rock throughout all of that and then 

Howard: so um so the big the big cities there are Dubai and I'll be due by early pronounced the same like that is it by and by yeah yeah stays in the US and it's the biggest geographically

Dr. Geoffrey Sharpe:  Dubai as more people there's 3.2 million people living in and there's five million living in the whole country man Elmo Queen rockin and Fujairah so those are probably somewhat less well known around the world so when you're in a foreign country you're from England and Dubai with three million people how are you accepted by the patients and the competition the other dentist who does the dentist across the street is he glad a dentist all the way from England came to compete with him across the street or is it does he like that is he not like it you know how does that work yeah okay so the first thing to understand is this and the the population of this whole country is heavily skewed towards people like me the local citizens the Emiratis as I know the people that are you know born and raised here never and have a UAE passport they this two hundred fifty four thousand of them in Dubai yourself out of a total of 3.2 million so that so they make up less than ten percent of the of the total population of the city so or extremely mixed group of nationalities cultures everyone candy here has got their own I mean you just heard my story everyone hold my patience they've got similar stories of their own about why they were drawn to this place and and that is one of the things I think that's fantastic you know they're so grateful they're people typically don't like it's not usually their favorite thing to do but I find that that here more than anywhere else people do tend to appreciate what we're doing and my assistance so it's so much fun meeting people and it's so much fun having them as my patients here so the other dentists say I think a lot of them are in the same same situation as me then not necessarily probably quite a small number of them are citizens of the UAE they're all foreigners like me that have got a license and they work in a clinic or they have their own clinic so blessed to have some really great colleagues that refer to me some of them I met when I first arrived some of those relationships are developed over the years but I think as with so many other places the landscape is changing and you know we're seeing bigger and bigger group practices something

Howard: very subtly just now that just punched me right in that face I mean it's of importance you said you've been the visiting specialist and you believe this serves the business owner probably more than the patient or even the specialist so so I want you know I think dentistry should be patient centered and said a dentist centered well what did you mean by that

Dr. Geoffrey Sharpe:  well going back to my days in the UK I told you I was that visiting specialist in quite a few clinics and right from the beginning that you know I was asked by quite a few practice owners to come and join them you know they found out and I graduated it's like hey you know we'd love to have a periodontist for a day a week and it's flattering you know when you're in that position and you're being headhunted it's valued but to be honest I never felt comfortable being the part-timer in somebody else's business and I get it from the from the business owners point of view they  want to offer that one-stop shop they didn't want to refurbish its outside that you know they're sending business out the door which which I don't think is the right way to see it to be honest it shouldn't necessarily be like that I think we should want our patients to have the best care from the right person so the  tell-tale sign for me is that associates are never the ones saying hey people coming to work in our practice let me ask my bosses we can have you for a day a week an associate calls me up and says an artist where do you work  this is really my and going to another clinic this is the other argument practice owners always say practice a I don't think it really matters to practice B they just want to get a right treatment they want to know that they're being sent to a trusted colleague who's gonna do a good job and I think if it's done right referring outside can actually help the relationship between dentist the first thing I say to a patient when they come and see me I say it's great to meet you doctor Ferran told me all about you I'm so happy that you're here I know you would love to have treated you himself but he obviously just wants you to get the right treatment and he's a great dentist and as soon as we finished with you here and of course I'm gonna go back to him and he'll carry on with all of your routine checks and everything else you need so try and be there referring them to stuff as much as I can and I think to people don't always appreciate it these referrals can go both ways if you know more and more people land on my website they find me they think they need to see me they come in for the consultation but

Howard:  so my gosh do they love Tom Cruise and Dubai after he jumped out of an airplane 70 thousand meters in the air and you know yeah is he a big deal in Abu Dhabi enthusiastic about Dubai to host the World Expo so the government and everybody here is really really focusing on man our butts I think that's going to be huge and every single country from around the world pretty much is gonna have a pavilion a year and get to showcase their country and of course they're all gonna come to the UAE and we get to showcase them so so talk about the expo the World Expo is that a really big deal

Dr. Geoffrey Sharpe:  yeah it's huge it was announced a few years ago that won the bid to host it and ever since then it seems like every almost every sector has been really full steam ahead getting everything ready there's a huge new airport being built there's the Expo site itself I don't know how many thousands more hotel rooms it's just in the next year and

Howard:  that actually started in London in 1851 so that was a British innovation so my first question whenever were number I'm talking to a dentist in another country then where I was born the first thing I always want to get to is a you know epidemiology I mean you know there's people listen to you from you know a lot of countries right now how is caries pareo and occlusal disease is there any differences between caries pareo and occlusal disease and say Dubai United States Canada England Vietnam I mean do they have unique factors and Dianne their culture does anything do they have water fluoridation how was it different you obviously know England and Dubai so how are they different from a epidemiological 

Dr. Geoffrey Sharpe: point of view access to any hard facts and figures to back it up water fluoridation no we typically drink bottled water here the drinking the mains water supply is safe you know that they're always being told that it is safe to drink but I think the issue comes not from the supply but from the storage in the individual buildings you know I guess it just depends on the individual home or apartment building how how clean otherwise that water is stored so water so that's not fluoridated in my experience yes all three of those diseases that you mentioned carries carrier occlusal diseases they do seem to be much more prevalent here now it's hard to know exactly why and again my patient base they literally come from you could pick a country and I probably got a patient who comes from that country they're not all born and raised right here in Dubai in fact probably very few of them are but most of my patients are expats just like me so they will have been exposed to whatever influenced their upbringing in Europe or the u.s. or Australia or somewhere else in Asia so there's an awful lot of variables what I can tell you is that diabetes so that has a huge impact on on my the laces say 19 populations do you suffer from diabetes don't know of course is how many people are undiagnosed you know there must be you know millions people walking around with undiagnosed type 2 diabetes so that's extremely high that has an impact on on perio  it's almost part of the culture here a lot of the Arabs smoke she said the water fight so that's extremely popular tobacco is she anyways and they recently slapped on a huge excise duty on cigarettes but still I think they're much much cheaper than other countries around the world so high incidence of diabetes high incidence of smoking I think both of those raise the incidence of periodontitis I don't personally treat a lot of carries but I see a lot of it's pretty here

Howard:  yeah that region has the highest one of the highest in the world I mean of diabetes some and the two and the two main causes of diabetes are genetics and lifestyle but you know what you know every humans always you see the same errors as you jump from different different genres but you know like in stocks like from 93 to 2000 people just kept literally extending that line and they're writing books now forty thousand and I think as a diabetes starts rapidly going high those young baby kids are gonna be looking at dad sitting there on that couch fighting diabetes with a cigarette in his hand Burger King and say not for me so I have so much faith in the individual and I think what goes up must come down it's all cycles but they'll figure it out but it's a first world problem because it's from being real rich real fast right because I remember one time I was in our I forgot where he was a he was a  at Tunisia but anyway I was in Tunisia and you see the rich people and this dentist lab he says see that guy in that mercedes-benz oh he thinks he's on top of the world but look at him getting out of the car and he was obese and all this stuff and he you think the people walking down the dirt road were poor and they were sad but all they had six-packs here giggling they're happy they're healthy and it's like you know you someone might think from far away the guy in the Mercedes rich it'd be happier but you'd much rather be that poor kid walking the dirt road giggling with his friends than driving in that rich Mercedes so you know I actually you know I I can't say I feel sorry for a periodontist because when you compare how much feel sorry for a pediatric dentist no one else even makes the list you know I mean I am I can't believe those guys even exist but anyway um pareo I mean when I get out of school in 87 it was all this training and everything to save it - there was scaling and root planing and every three months and they would just go to the moon to try to say that tooth and it wasn't even ten years people thought you know what you know how you treat pareo with titanium let's pull that stupid tooth out it's useless we can improve the human condition by pulling out natural parts and replace some titanium and that went on for about ten years and now everybody I see looking at that and saying well that wasn't so much a good idea and now you see the pendulum swinging back toward into saving some more with a trifurcation and a nine millimeter pocket and and my parents like you know let's just try a little more so I have so pendulum went from aperio to ol titanium and it's coming out where we're where's your that pendulum be if it was hanging still on the bottom instead of swinging right to left where should the pendulum be you're talking to a lot of kids right now and it's tough for him cuz they come back they come out of school they go back and work with their mom and dad and they sitting there looking at this tooth then it's had a you know an eight millimeter pocket every three months for so where should the pendulum rest 

Dr. Geoffrey Sharpe: yes not just not really having access to implants they were supremely expensive and you were only available to a limited number of people in 98 and I think you know before that you had to go on Branagh market own course before they would even sell you the implants so they just accessible to a lot of dentists in there for a lot of patients and of course you've got thousands of different companies making implants and the training has become more and more accessible so I've seen a lot of that contributed towards this towards giving up on teeth in my opinion a little bit too soon titanium and I think it's right that the pendulum is swinging back I think there's an awful lot that we can do now to save teeth or at least really slow down bone loss I don't really buy into this concept of having to extract teeth to preserve bone I think there's a lot of a lot of a lot of what we can do to preserve good functional teeth without resorting to extracting them all and then who knows what's going to happen in the future we've got you know periodontitis that's very  implant I just going through the roof so yeah I think it's I think it's only right that that pendulum swings back again and where we can predictably keep teeth then we should do so and if we hang onto a tooth through another 5 10 15 years well that's another 5 10 or 15 years that you could add up to a life of your life expectancy of your implant so yeah I think I think the pendulum is coming back and I think implants definitely have their role of course we should be to just do this wholesale extraction of teeth that could potentially be be maintained

Howard: so over a decade 12 13 years as a periodontist you always wondered like the who are you the periodontist and you wag your tail or does the referring dentists Wagga Wagga you around I mean how many implant systems do you have to have to keep your referring doctors or do you think that's a wrong approach to relationship and when they say hey I want you to place noble bioterrorist ramen or then slicer owner or Zimmer or bio raisins or implant direct or Hassan or am i ask you say no no no no no I this is what I use the patient comes first I use one so so how many implant systems do you have what is your one because I was working at the time it was 

Howardanother thing that's all over social media is that paradol disease causes heart disease and then you start getting a big debate okay when I get up this morning this is a true story I turned on my coffee pot and every time I do that the Sun comes up and I know it's me how else could this thing so how do you is this as a teaching lesson you share with patients is it something you keep yourself do you believe it not believe it 

Dr. Geoffrey Sharpe: well what would you say if a patient said well my gum disease causes a heart attack is that we are seeing more and more associations of gum disease and heart disease and those two conditions seem to occur together in similar groups of patients I still haven't seen any really compelling evidence to say it if we treat your periodontitis you're gonna reduce your risk of having attack or or heart failure or whatever so I just I think a lot of these a lot of these suggestions are pretty plausible I mean you had dr. Bailey Bailey fantastic interview with you and I read his book just risk of all the periodontists are always the ones saying hey we've gotta treat this film is because you might get a heart attack it kind of makes us look a little bit desperate if we don't have some really compelling evidence to show that what we're doing is gonna it's gonna offset that there was some causal link between inflammation in the mouth or specific pathogens in the mouth and cardiovascular disease then the ideal scenario would be to get cardiologists on board and have them driving this cardiologists be the one to say wow you know we found this in your in your bloodstream or we found this bacteria you really should go and see your dentists you know I think if they are the ones advocating for us I mean so much more powerful than dentist scratching around desperately searching for a way to treat more people 

Howard: so you've been using a dense flight Sirona Astra for a decade doing these implants and so my question is when they talk about implant failures it's um it's  so tough to talk about because when you look at the studies are always putting them in you know d4 anterior bone to where he'll that didn't even work it'd still be wedged and stuck in there as opposed to a maxillary bone did it fail out of the gate because you know just didn't never took or did it fail long-term but when you look at the implant you know start without peri-implantitis do you think the major implant companies that some surfaces are less likely to get peri-implantitis and others or do you think peri-implantitis like we're talking about diabetes is more to do with genetics and diabetes and smoking as opposed to the surface of the implant cuz remember they used to have h8 coated implants hydroxyapatite implants 

Dr. Geoffrey Sharpe:  you look back through the history you know the very first cases that were treated there were all the dentist patients you know they were they were they were done in Scandinavia people who've been wearing complete dentures for years and they are these of course they have hooves or bridges and they had these huge long abutments with with a fixed lower bridge and two things first thing is those are really easy to clean you know they're far away from the tissue and they had meticulous follow-up they were always seeing IDs they were always being instructed how to keep all of that super clean and I think when when implants are placed in an indent Sheila's mouth then there is no PG or AAA or any of these horrible nasty pathogenic bacteria because all the teeth are long gone so I think dentists at that time saw how successful implants could be and they realize that Osseo integration was predictable and they saw anything like the amount of peri-implantitis that we're seeing now then I think as a profession we got carried away and we start pushing the envelope and as you say newer surfaces were developed in rougher surfaces to allow the implant to integrate much faster but as soon as that as soon as that surface becomes exposed to harmful bacteria particularly you know partially dentate mouth that still does have all these pockets then of course that surface is gonna get colonized quite quickly and then huge very fast around an implant 

Howard: so another thing that dentists do you know I always called a red flag when I see it in our tribe and not a bunch of other tribes but man you could talk to a hundred physicians for ten hours each and none of them would mention any brand name equipment - have you talked to a dentist for five minutes new son he's got a laser he's got on a map he's got a CAD cam he I mean it's almost like they're their whole ego is defined by their technology I mean it's kind of like telling Kansas you know those boys never 14 they wanted the big old pickup truck you know there was a there was the modern-day cowboy riding a horse but but this stuff's expensive like what maps a hundred and thirty-five grand and I got kids listening to me that didn't have student loan debts they bought it practice they got kids you know they got a tuck in at night and feet and and there skin I want to treat peri-implantitis I'm trying to be an implant ologist or I'm a periodontist should they buy a hundred and thirty-five thousand dollar one apt to be better in 2018 and it was one of their best evidence consensus guidelines about the use of lasers in the treatment of periodontitis and the peri-implantitis and they were still fairly on on the use of lasers for treating both of those conditions a lot of their members are certified 

Dr. Geoffrey Sharpe:  I think if you're spending that kind of money then of course you're gonna find reasons to use it actually yes lasers are far superior and that's going to be the standard of care but I don't think we're there yet I do think I think that's it's really sort of the individual dentists if they're really  into that kind of technology if they if they think that there's a market for it if they think you can use it if they can you know I do know feeling with it to afford the repayments and then why not it's another string to the bone I think there are many different ways of dealing with all of these different conditions and again it all comes back to consistency finding the way that works best in your hands learning system and deploying it 

Howard: yeah and I got it I got to teach the kid something you know I trying to teach them us a lot with channel conflict so we know you have to money is the answer what's the question you gotta tried it when you listen to someone else Joe he's got to say what is the cultural power you know what could be a reason explain this for what is the American Association a periodontist what is their ultimate goal to get every single Per Dentist us on earth to be a member so what would be really dumb for them to do oh let's say piss off every one of them that owns a laser and loves the map so you know and the 88 you know they you know when I went down there - you know that - 11 Chicago I went down there one time with Gordon Christian and you know we were talking to those guys and I and one of the reasons they don't like to make a lot of decisions they don't want to fracture their herd you know I mean so it's like when they start talking about a television commercial for gum disease your profession they in five years they couldn't agree on the wording of a 60-second commercial but but he's like but it's good because it's like therapy they're there they're talking they're working on it you know they're working out there aints and now are they ever gonna make a damn decision of course not they could never make it as a they said you can't get a hundred thousand dentists to agree that today is Monday let alone what you're gonna say on a commercial so so I wouldn't look for the American Association of pari honest if you if you wanted to find another reference for lasers who would you go to who would be your next vessel someone that would have less as much prestige but less channel conflict 

Dr. Geoffrey Sharpe: well truly independent if you've invested all that money in a laser then then you're gonna use this you know it's not gonna sit around in the cover and gathering dust so it's it's really polarized the the profession I think there are those who have invested our money and by the way we're seeing a rise in treatments like Lana which is which is trademarked you know you can't just buy any other laser and say you're off because it's not protected there and this is a because you know back in the day would come up with something new they would in a peer-reviewed journal published their results and so do you my problem is when I pull up that paper the the the the websites coming up in French I'm like okay so I'm peri-implantitis so so we talked about lasers um what do you think is the what do you think is the biggest risk factor for pear implantation well first of all how significant do you think it is so let's say you placed a hundred implants and at just ten years one placement you know ten years what percent have peri-implantitis and of those how many are gonna have to be extracted and redone yes well what the essence is it probably is gonna vary but it's you know anecdotally we're seeing more and more of it and you know you talked about removing the implants that's almost as a last resort but it's it's very very challenging to to manage peri-implantitis in a way that keeps everyone happy because you've already lost bone you probably gonna end up losing a lot of soft tissue around the implant probably with a lot of extra stress and if that's in the cosmetic zone then that's an absolute disaster so it's it's it's it's just a horrible thing to have to deal with when a patient comes in with with peri-implantitis they often don't have any symptoms as far as they're concerned that implant is rock solid they can eat with it it's not painful but then you find these huge pockets and and pus coming out and bleeding huge amount of bone loss on the x-ray so I think the key thing really is to try and prevent it as far as we can and in my opinion one of the things that's vastly overlooked these days is at least offering some initial period-- treatment while the teeth are still there get the patient on board teach them how to look after what they have and and again try and try and shift that that really harmful pathogenic bacteria to a slightly more favorable friendly bunch of bugs and I think the in just simple non-surgical treatment can do that in a lot of cases but I don't think just taking teeth out taking infected teeth out and immediately putting in implants I don't think those bacteria disappear overnight I think I think it takes time to for them to evolve and for them to improve so I'm a big fan of slowing things down a little bit to start with at least try and stabilize some of that inflammation in the in the mouth she's a little bit more healthy and then if the teeth definitely can't be saved and of course implants might be an option rather than just completely disregarding the etiology never seen another you know 

Howard: I'd like to talk about you know the  trigger points the things that make people to set I in fact if you're thinking about not sending me a hate email please send it that's you know and III wouldn't I want to know where your buttons are I want to know what we're how you're how you're thinking and what you're thinking about but all in for is a very emotional deal a lot of people you you start talking about all in for name a low on for you mean you mean not on three and you know and they and there's they also you know when you're a trained periodontist your whole life you're trying to say bone and then you go do it all on four and they just whack off you know a centimeter of alveolar bone trying to make room for the prosthesis and so so I'm just trying to trigger a few buttons on you what's your thoughts on on for is it all on three is it not very conservative to have to erase a lot of alveolar bone to make room for there are situations where

Dr. Geoffrey Sharpe:  I think perhaps in series thing is the median age group in Dubai is the 34 year old age brackets I think that's young to be pulling out every single tooth 85% of the population here less than forty four years old that's my age so you know we're dealing very very young population I think there's an awful lot to be said for maintaining what we can for as long as possible and the unfortunately it does get a bit challenging because the population here is pretty transient you know I talked earlier on about my own my own backstory I thought I would be here for a couple years at Here I am ten years later but there are people there  are so many thanks pastor you know there might be two years three years or less and then you move on to the next posting with the company or with an employer and people coming so I think having the long term follow-up and seeing people and establishing that relationship is much harder in this in this part of the world and it might be so when you is your practice more likely to be expats or is it our the originals the people the ten million is Emiratis and what percent are expats oh I can tell you the divisor as a whole yeah five million is 

Dr. Geoffrey Sharpe: the population of the country only two hundred and fifty four thousand of those are Emirati so it's it's ten percent or less and I think those numbers probably transfer pretty well to my practice and we welcome everybody and but just because of a cup of the country the vast majority are equal of or excess and we probably see maybe slightly more bricks or europeans than anybody else just simply because i'm a brand and people tend to feel comfortable with people from their own background but as I said before you people from literally just about every country you can imagine very very hospitable welcoming people there are absolute pleasure to treat I think one of the reasons why I as many of them they have access to in the private market which is where we are so this there's just over two thousand dentists in 2163 serving predominantly markets so you know we we say in dentistry 

Howard: we got three diseases you know they say Carrio pareo and occlusal and you know the occlusal is the most controversial and in care these are caries Perry owes in the middle how much do you think Perry Oh is affected by occlusion I'm trying to make at least a hundred dentists on dental town just want to kill you it's so emotional but but anyway and and I'm really excited about it clues to the most because it's been the most controversial for thirty two years obviously but I think a lot of its because in caries there's a lot of objective measurements I mean you look at bite Wings in a dental school everybody agrees that's a cavity that's not our watch Perry oh you got the pair probing measurements you see them every three months you got all kinds of objective data but it closely you don't but now you do because you know they and visit line technology owns Invisalign and I Taro and they've done millions and millions of scans and then they hire they got a lot of money so you hired a lot of AI people and they're actually everyone's saying man we're gonna get measurements objective data they've been talking about this for two years but I hear a lot of teams wrapping up with it glide wells on it a lot of people are on it so occlusal you know when you start looking at occlusal data for millions of scans and you got a TMJ theory that can't account for this big but now where do you see a clue so obviously you're more likely to start moving and contact or some of the type of the puzzle interference can progress quite rapidly bacterial assault and the immune response in the first place the inflammation 

Howard: Gordon Ghristians research letter from 2018 said anyone have pocket death reduction to practice using pro dentist by olga cultured care probiotic gum pro by or pro we Viton are you having any any luck with any that probiotics stop microbiome er mm-hmm

Dr. Geoffrey Sharpe:  you know I think but my my feeling on that basis the microbiome the oral microbiome it's it's it's pretty well-established she's got to work hard to influence that you know and we know that a lot of these bacteria are carried throughout families through generations through genetic passed down and I think yeah you can you can take a probiotic and populate your mouth with friendly buzz probiotic so I think again it's always about you've got to get the basics right you've got to get the patient in in a situation where they are able to reliably remove those harmful bacteria on a daily basis clean properly especially between the teeth in all those difficult areas stop the most harmful bacteria from ever developing and maintain that healthy gram-positive aerobic rather than ropes that are gonna course gum disease and peri-implantitis so I think it really does come back to those  basic principles and the messages that we should be giving our patient sometimes new friends or new research foundation they're all very clear you brush twice a day you use a fluoride toothpaste you clean between your teeth once every day you you spit out your toothpaste you don't rinse it all the way with water and you limit the frequency that you have sugar in your food and drinks you know those are the core message no difficult for us as dentists to understand but there I think they got a lot some on a lot of patients because we've over complicated it or we're too busy to explain it properly and you know they come in with a cavity and they say yeah three times a day well intake sometimes

Howard:  so when you're when you're a periodontist for a decade and you see referring doctors and not understanding what you understand what would are their errors where do they not get I mean obviously a periodontist you know your personal framework is all pareo whereas a general dentist is spread out over it when we don't understand the way the elite periodontist think where's our mental errors I mean obviously they know an oral surgeon can pull four wisdom teeth faster than them and everybody knows that if you're if you're full-time you obviously know the same thing again 

Dr. Geoffrey Sharpe: they're probably gonna use better magnification they might use different instruments well they're gonna clean and shave that root canal they're gonna remove the old root feeling they're gonna disinfect and they're gonna fill but again they've done it in that consistent way they know works they've got their routines in place they've probably set their practice to allow for all of those systems there they're consistent in the way that they do things sometimes I feel like dentists are genius they they do some non-surgical pareo and they refer to me and they're expecting me to work miracles they think I'm gonna pull some you know fancy surgical procedure out of the box and I examine that patient and they're all hiking's not good I might find residual calculus here and there and and I really want to do some good quality non-surgical treatment to do it in the most efficient way that I can you know let's again focus on the basics do things right some difference or failure of the treatment really hinges on the patient's engagement you can't just get your ultrasonic scaler and waving around there for a few minutes and think that you're gonna cure somebody it takes time and I think it takes time to explain the disease process disclose massively and use technique and it's completely impartial if you use a disclosing agent it's not you or the hygienists telling the patient uh they're not brushing properly they can see their own plaque they can see where they've missed brushing and I think when it comes to to that initial phase of of non-surgical treatment that you know most dentists and hygienists and a lot of your young listeners are probably gonna get involved with then you need to use the right instruments I use a minimum of three tips on my ultrasonic you need a straight one it should be very fine so it gets into these these deep narrow pockets you need to do the cleanings afterwards with with just a bunch of so you can see what you're doing then you can do surgery there are times where we need to huge a bone recontouring 

Howard:  so I mean when I was got out of school in 87 I'd go to these cosmetic dentistry courses and I would cringe I mean some person would come in with all these crowded teeth and they prep everyone I'm down for a crown and a lot of them look like rice curls and they were done and had to have it like the window and then you notice that when his 18 year old daughter wanted straight white teeth he made her go to the orthodontist for two years and get bleaching so whenever you're seeing the profession treating their kids different than the public for money that therein lies the red flag I mean you know it's always been said that world peace will break out when everybody makes decisions based on what's best for their own baby then what's best for getting back at that guy that you don't like you don't I mean it's like forget the guy you don't like what's the best decision for your baby so um so you know when it comes to a dentist and then I have this in my practice you know a hygienist that's been you know fighting a ten millimeter pocket for fifteen years and say she's doing everything to hang onto this tooth then when it's not a hygienist you know no they're like wow that's been gone a long time I think we need to step up the treatment do some more aggressive pull the tooth and do an implant okay so the the the the people that are Pro titanium they always say they always say yeah well you know what are you doing it's supervising like you've seen this lady every three months for ten years and she still got all this stuff going on and and so it makes the hygienist and then I feel bad because I think well it is kind of supervisors neglect I mean she comes in every three make sure we've never cured her from perio and so so what would be your answer to that be 

Dr. Geoffrey Sharpe: well you you can you can manage well you can stabilize it you can keep it under control but they have to be maintained then they have to be down to the patient and it's a you know there's so many easy rules of thumbs to make better decisions and one of them is you know is this decision best for your baby or 

Howard: best for revenge is um you know when you hear people talking about themselves like would you say that to your own child like you got a baby boy right one year he's like okay is that the advice you'd give your one-year-old son 20 years from now and he was in college and and and when when people are talking crap about dentistry or themselves or their hygienists or whatever it's like would you talk that way if that was your child you know if your hygienist was your daughter would you have just said that those words so you know there's 

Howard: so many things to keep it real um what and I don't know we went over and you're such a saint I mean gosh it's uh it's only 3:30 in the afternoon on Monday here and it's two o'clock in the morning and and debye and he's there he is all bright and shiny another big one is Perry Oh protect there's a lot of people who believe if I take these impressions and make these trays and soak these teeth imperio protect and then other people make trays but you use a chlorhexidine gel or do any of these mouthwashes gels products this isn't me that having an impact on paradoxes 

Dr. Geoffrey Sharpe: well my question there is get into any residual pockets they probably do a great job on the surface they probably do a great job where they're actually in contact with the tissue but those are areas that should also be accessible for good brushing and flossing pocket six seven eight nine millimeters or more I just wonder whether any topical agent penetrating deep enough to do what it's supposed to do 

Howard: so you would say no then that was that was a no so so so you have someone on three months recalls some people wonder well if I make trays pareo protect if I start using antibody sometimes I know Dennis you just when they're three months recall comes on they throw them a scrip of a tetracycline because they learned a hundred years ago that the cycling show up in the gingival crevicular fluid about seven times more than penicillin some do the perio chips some trading and all their patients to go from brushing and flossing to water picking and ultrasonic do you see any of those do you think it's more look it's genetics you got diabetes you're smoking and as I'm explaining this to you you just took a shot of Jameson is that more of the deal or is these over-the-counter products toothbrush mouthwashes is is all that a deal 

Dr. Geoffrey Sharpe: well I think every everything you can do to offset complex and irrational and response to different incentives so I think you can find a way to what we think is better in certain clinics and you know almost like a need to do something to offer something you know do some treatment if you're charting your time properly then I think education is important my my colleagues in the u.s. is this way you can clean between your teeth traditional dental floss easier  penetrating deeper into the into the environments but that's the do any price they're not really necessarily a lot of bacteria you know it's quite hard to expect physically everything from  under the gums whereas correctly sighs incidental sweep 

Howard: so uh my gosh I can't believe how I'm fastest went over an hour is there anything I can't believe it someone didn't agree with me

Howard:   yeah I mean that's great I mean gentlemen can disagree I don't want anybody degree me you know I like to to take their mind out for a ride you know go out and start thinking this stuff up and I know all the kids think their Grandpa's crazy I know my grandpa was crazy but that doesn't mean that they can't say something that make you make you thinkit was amazing and the only reason this show is a success it has about 1% me and 99% guys like you parried on us in two by two o'clock in the morning showered with a tie on ready to kind of talk to their sovereign professional colleagues I loved dentistry for that I mean you can go I mean is I heard so many love stories about dentists hell there's a debt there's a threat on dental town some Dentist dad is dying and his dying request was to meet this movie star he just shared it on dental town another Dentist found the guy who set it up I mean it's like yeah it's just a really tight trying and ya know the eleventh commandment is don't eat your young you know don't I mean we we got so much crazy patients and staff and insurance and whatever the last person you're gonna attack is another dentist on the front lines of kareo periode occlusal and you are on that front line thinking outside the box crushing it and Dubai and on your last email but thank you so much for coming to show and I hope you get enough sleep before you going to work alright have a great day buddy 

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